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NPI Code Detail

MEDICARE: LISA MARGARET CORSTVET MD

MEDICARE: LISA MARGARET CORSTVET MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician16541OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00398663OTHEROKMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1612216600OTHEROKDOL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083628044
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARGARET CORSTVET MD
Provider Business Mailing Address
First Line : PO BOX 975008
Second Line :
City : DALLAS
State : TX
Zip : 75397-5008
Country : US
Telephone Number : 405-418-4800
Fax Number : 405-418-4820
Provider Business Practice Location Address
First Line : 4317 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-1720
Country : US
Telephone Number : 405-418-4800
Fax Number : 405-418-4820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/31/2020

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