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NPI Code Detail

MEDICARE: DR. LISA HALLER M.D.

MEDICARE: DR. LISA HALLER 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
1207RN0300XNephrology Physician43090WI

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 : 1245204858
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA HALLER M.D.
Provider Business Mailing Address
First Line : 2514 S 102ND ST
Second Line : SUITE 120
City : WEST ALLIS
State : WI
Zip : 53227-2142
Country : US
Telephone Number : 414-777-5200
Fax Number : 414-777-5210
Provider Business Practice Location Address
First Line : 5650 N GREEN BAY AVE STE 210
Second Line :
City : GLENDALE
State : WI
Zip : 53209-4447
Country : US
Telephone Number : 414-431-5971
Fax Number : 414-434-0354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 02/09/2022

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Directions to “ DR. LISA HALLER M.D.” Practice Location

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