MEDICARE: LISA TRITTO 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	208000000X	Pediatrics Physician	2024041787	MO
2	2080B0002X	Pediatric Obesity Medicine Physician	74526	MN
3	2080B0002X	Pediatric Obesity Medicine Physician	2024041787	MO
4	208000000X	Pediatrics Physician	01057237	IN
5	208000000X	Pediatrics Physician	036.148965	IL

General Provider Information

NPI Number	:	1326137159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA TRITTO MD

Provider Business Mailing Address
First Line	:	7301 PRINCETON AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-2923
Country	:	US
Telephone Number	:	314-200-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 PRINCETON AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-2923
Country	:	US
Telephone Number	:	314-200-5050
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/16/2024

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Directions to “ LISA TRITTO MD” Practice Location

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