MEDICARE: DR. LISA MARIE ALLEN D.O.

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	207V00000X	Obstetrics & Gynecology Physician	5101009894	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639203102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE ALLEN D.O.

Provider Business Mailing Address
First Line	:	3257 DAVISON RD STE 102
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-2581
Country	:	US
Telephone Number	:	810-245-8620
Fax Number	:	820-245-8623

Provider Business Practice Location Address
First Line	:	3257 DAVISON RD STE 102
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-2581
Country	:	US
Telephone Number	:	810-245-8620
Fax Number	:	810-245-8623

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	11/28/2022

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