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NPI Code Detail

MEDICARE: LISA S SPLITTSTOESSER M.D.

MEDICARE: LISA S SPLITTSTOESSER M.D.
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
1207R00000XInternal Medicine PhysicianMD27782ME
2207R00000XInternal Medicine PhysicianMD27782HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111865OTHERHISTATE LICENSE

General Provider Information

NPI Number : 1124021944
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA S SPLITTSTOESSER M.D.
Provider Business Mailing Address
First Line : 2560 APAPANE ST
Second Line :
City : LIHUE
State : HI
Zip : 96766-9611
Country : US
Telephone Number : 808-634-7006
Fax Number :
Provider Business Practice Location Address
First Line : 19 SAINT ANDREWS LN
Second Line :
City : BOOTHBAY HARBOR
State : ME
Zip : 04538-1732
Country : US
Telephone Number : 207-633-7820
Fax Number : 207-810-4966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 05/07/2024

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