MEDICARE: DR. LISA MICHELLE MOFLE 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	207Q00000X	Family Medicine Physician	4093	SD
2	207Q00000X	Family Medicine Physician	31043	IA

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	:	1710961511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MICHELLE MOFLE M.D.

Provider Business Mailing Address
First Line	:	2 S KANSAS AVE
Second Line	:
City	:	PLATTE
State	:	SD
Zip	:	57369-3300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 N TERRACE DR
Second Line	:
City	:	WEBSTER CITY
State	:	IA
Zip	:	50595-3063
Country	:	US
Telephone Number	:	515-835-2541
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	03/11/2024

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