Healthcare Provider Details

I. General information

NPI: 1508798638
Provider Name (Legal Business Name): LISA MARIE GILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 ROMIG RD
AKRON OH
44320-3879
US

IV. Provider business mailing address

2180 ROMIG RD
AKRON OH
44320-3879
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-3406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number007519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: