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General NPI Number Information
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NPI Number | 1184840043
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Entity Type | Individual
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Provider Name | LISA WEIDER KLANKE MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 6551 CENTERVILLE BUSINESS PKWY STE 110
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City | DAYTON
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State | OH
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Zip | 45459-2696
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Country | US
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Telephone | 937-291-6850
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Fax | 937-291-6896
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Provider Business Mailing Address
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Address Line | 25 MERCHANT STREET SUITE 220
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City | CINCINNATI
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State | OH
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Zip | 45246-3740
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Country | US
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Telephone | 513-533-6507
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Fax | 513-645-9767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57-010522
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.091257
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License Number State | OH
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