MEDICARE: LISE AMY LABICHE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	2356	WI
2	2084N0400X	Neurology Physician	036-162508	IL
3	2084N0400X	Neurology Physician	K9830	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00477936	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	K9830	OTHER	TX	TEXAS MEDICAL LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487621306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISE AMY LABICHE

Provider Business Mailing Address
First Line	:	PO BOX 678186
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-8186
Country	:	US
Telephone Number	:	303-306-7783
Fax Number	:	303-306-7753

Provider Business Practice Location Address
First Line	:	3535 S INTERSTATE 35 E
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-6850
Country	:	US
Telephone Number	:	940-384-3535
Fax Number	:	303-306-7753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/04/2024

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Directions to “ LISE AMY LABICHE ” Practice Location

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