MEDICARE: LISA KAY PETINIOT 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	208000000X	Pediatrics Physician	35.082974	OH
2	2080P0216X	Pediatric Rheumatology Physician	35.082974	OH

General Provider Information

NPI Number	:	1134336100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAY PETINIOT M.D.

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 7015
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4266
Fax Number	:	413-636-3549

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 7015
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4266
Fax Number	:	413-636-3549

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	02/02/2015

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