MEDICARE: DR. LISA CORNELIUS 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
1	207RI0200X	Infectious Disease Physician	L6844	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00047686	OTHER	TX	RR/MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8J0636	OTHER	TX	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1596207-02	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1538129481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA CORNELIUS M.D.

Provider Business Mailing Address
First Line	:	1100 W 49TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-776-6309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W 49TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-776-6309
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/28/2014

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

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