MEDICARE: LISA RENEE CLAY 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
1	208M00000X	Hospitalist Physician	01065883A	IN
2	207Q00000X	Family Medicine Physician	01065883A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1124228010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE CLAY M.D.

Provider Business Mailing Address
First Line	:	90 EXECUTIVE DR STE A
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-2612
Country	:	US
Telephone Number	:	317-804-4203
Fax Number	:	317-564-0627

Provider Business Practice Location Address
First Line	:	90 EXECUTIVE DR STE A
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-2612
Country	:	US
Telephone Number	:	317-804-4203
Fax Number	:	317-564-0627

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	01/14/2025

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