MEDICARE: DR. LISA HYET-MCLAIN

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
1	183500000X	Pharmacist	5302036368	MI

General Provider Information

NPI Number	:	1083990055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA HYET-MCLAIN

Provider Business Mailing Address
First Line	:	848 S KALAMAZOO ST
Second Line	:
City	:	PAW PAW
State	:	MI
Zip	:	49079-9230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 S KALAMAZOO ST
Second Line	:
City	:	PAW PAW
State	:	MI
Zip	:	49079-9230
Country	:	US
Telephone Number	:	269-657-4984
Fax Number	:	269-657-8952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2011
Last Update Date	:	10/22/2011

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