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NPI Code Detail

MEDICARE: DR. LISA DITLEV ASTE MD

MEDICARE:  DR. LISA  DITLEV ASTE  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
1208D00000XGeneral Practice Physician180143 1205UT
2111NI0900XInternist Chiropractor1801431205UT

Other Identifiers

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

General Provider Information

NPI Number : 1225205941
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA DITLEV ASTE MD
Provider Business Mailing Address
First Line : PO BOX 270
Second Line :
City : PROVO
State : UT
Zip : 84603-0270
Country : US
Telephone Number : 801-344-4411
Fax Number : 801-344-4225
Provider Business Practice Location Address
First Line : 1300 E CENTER ST
Second Line :
City : PROVO
State : UT
Zip : 84606-3554
Country : US
Telephone Number : 801-344-4411
Fax Number : 801-344-4225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2008
Last Update Date : 05/23/2008

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