MEDICARE: LISA EMMANS 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	207R00000X	Internal Medicine Physician	29814	AZ

General Provider Information

NPI Number	:	1356417414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA EMMANS MD

Provider Business Mailing Address
First Line	:	10950 N LA CANADA DR
Second Line	:	22-204
City	:	TUCSON
State	:	AZ
Zip	:	85737-5940
Country	:	US
Telephone Number	:	480-221-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	10950 N LA CANADA DR
Second Line	:	22-204
City	:	TUCSON
State	:	AZ
Zip	:	85737-5940
Country	:	US
Telephone Number	:	480-221-6715
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/24/2007

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