MEDICARE: DR. LISA JUNE VIROSTEK 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
1	2085R0001X	Radiation Oncology Physician	MD28495	TN

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	:	1174547277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA JUNE VIROSTEK MD

Provider Business Mailing Address
First Line	:	2620 PEERLESS RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3732
Country	:	US
Telephone Number	:	423-472-2171
Fax Number	:	423-559-8032

Provider Business Practice Location Address
First Line	:	2620 PEERLESS RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3732
Country	:	US
Telephone Number	:	423-472-2171
Fax Number	:	423-559-8032

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/26/2012

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