Healthcare Provider Details

I. General information

NPI: 1376532879
Provider Name (Legal Business Name): LISA LARKIN, MD,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 RED BANK EXPY SUITE 100
CINCINNATI OH
45227-1548
US

IV. Provider business mailing address

1315 SOLUTIONS CENTER
CHICAGO IL
60677-1003
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-5111
  • Fax: 513-272-7084
Mailing address:
  • Phone: 513-421-3504
  • Fax: 513-231-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA C LARKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 513-271-5111