MEDICARE: DR. LISA KHANH LE M.D.

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	208000000X	Pediatrics Physician	A70998	CA
2	208000000X	Pediatrics Physician	022667	LA

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

General Provider Information

NPI Number	:	1770581381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA KHANH LE M.D.

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-526-0011
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	17609 OLD JEFFERSON HWY
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3979
Country	:	US
Telephone Number	:	225-647-8511
Fax Number	:	225-744-2992

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/04/2021

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