MEDICARE: DR. LISA MAXWELL 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	208600000X	Surgery Physician	01052947A	IN
2	208600000X	Surgery Physician	DR.0053436	CO

General Provider Information

NPI Number	:	1568438026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MAXWELL M.D.

Provider Business Mailing Address
First Line	:	675 COVEGLEN CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-6801
Country	:	US
Telephone Number	:	706-726-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 COVEGLEN CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-6801
Country	:	US
Telephone Number	:	706-726-5472
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	11/05/2016

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