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General NPI Number Information
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NPI Number | 1477644151
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Entity Type | Individual
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Provider Name | MICHELLE DIANE PISA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 800 ZORN AVE BLDG T-22
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City | LOUISVILLE
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State | KY
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Zip | 40206-1433
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Country | US
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Telephone | 502-287-6845
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Fax |
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Provider Business Mailing Address
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Address Line | 10813 MEETING ST
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City | PROSPECT
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State | KY
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Zip | 40059-7593
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Country | US
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Telephone | 502-468-1546
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34975
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License Number State | KY
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