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General NPI Number Information
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NPI Number | 1700856937
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Entity Type | Individual
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Provider Name | LISA M SCHOMOGYI MD
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 2510 E DUPONT RD SUITE 210
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City | FORT WAYNE
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State | IN
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Zip | 46825-1600
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Country | US
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Telephone | 260-969-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 10351 DAWSONS CREEK BLVD SUITE D
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City | FORT WAYNE
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State | IN
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Zip | 46825-1904
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Country | US
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Telephone | 260-969-1950
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Fax | 260-969-0988
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01049376A
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License Number State | IN
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