Healthcare Provider Details

I. General information

NPI: 1356340285
Provider Name (Legal Business Name): LISA ANN BARATTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/08/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19725 DAVIDSON RD
BROOKFIELD WI
53045
US

IV. Provider business mailing address

19725 DAVIDSON RD
BROOKFIELD WI
53045
US

V. Phone/Fax

Practice location:
  • Phone: 262-389-1202
  • Fax: 414-649-3551
Mailing address:
  • Phone: 262-389-1202
  • Fax: 414-649-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30716-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number30716
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30716
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30716
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: