Healthcare Provider Details

I. General information

NPI: 1912962788
Provider Name (Legal Business Name): LISA A EVEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S LOGAN AVE STE A
GREGORY SD
57533-1614
US

IV. Provider business mailing address

110 S LOGAN AVE STE A
GREGORY SD
57533-1614
US

V. Phone/Fax

Practice location:
  • Phone: 605-835-9611
  • Fax: 605-835-8033
Mailing address:
  • Phone: 605-835-9611
  • Fax: 605-835-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22311
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5085
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: