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General NPI Number Information
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NPI Number | 1700132537
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Entity Type | Individual
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Provider Name | LINDA LEWIS LISTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 6319 E US HIGHWAY 36 SUITE 4
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City | AVON
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State | IN
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Zip | 46123-6209
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Country | US
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Telephone | 317-345-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 8902 WATERSIDE CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1158
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Country | US
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Telephone | 317-345-6348
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01028295A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01028295A
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License Number State | IN
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