Healthcare Provider Details

I. General information

NPI: 1447253893
Provider Name (Legal Business Name): LISA M HUNSICKER MD, FACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 S BROADWAY SUITE 150
LITTLETON CO
80122
US

IV. Provider business mailing address

7750 S BROADWAY SUITE 150
LITTLETON CO
80122
US

V. Phone/Fax

Practice location:
  • Phone: 720-283-2500
  • Fax: 720-283-1122
Mailing address:
  • Phone: 720-283-2500
  • Fax: 720-283-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number36965
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: