Healthcare Provider Details

I. General information

NPI: 1295827624
Provider Name (Legal Business Name): LISA CRAFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S FLOYD ST SUITE 100
LOUISVILLE KY
40202-3828
US

IV. Provider business mailing address

571 S FLOYD ST SUITE 100
LOUISVILLE KY
40202-3828
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-7897
  • Fax: 502-852-7897
Mailing address:
  • Phone: 502-852-7897
  • Fax: 502-852-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43779
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number43779
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: