Healthcare Provider Details

I. General information

NPI: 1215165675
Provider Name (Legal Business Name): LISAL J FOLSOM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISAL J STEVENS

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST STE 403
LOUISVILLE KY
40202-1837
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3400
  • Fax: 502-588-3401
Mailing address:
  • Phone: 502-588-3400
  • Fax: 502-588-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number50222
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01072641A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number01072641A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number50222
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: