MEDICARE: LISA BAKER SCHOEN 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	2084P0800X	Psychiatry Physician	25885	KY

General Provider Information

NPI Number	:	1306879408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BAKER SCHOEN MD

Provider Business Mailing Address
First Line	:	10401 LINN STATION RD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3842
Country	:	US
Telephone Number	:	502-589-8600
Fax Number	:	502-589-8771

Provider Business Practice Location Address
First Line	:	4710 CHAMPIONS TRACE LN STE 107
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-4490
Country	:	US
Telephone Number	:	24-546-3435
Fax Number	:	502-459-9209

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	06/18/2020

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