MEDICARE: LISA LYNN MARTIN 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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	01056225A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3422489001	OTHER	IN	CIGNA INS.
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821046202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LYNN MARTIN M.D.

Provider Business Mailing Address
First Line	:	1542 S BLOOMINGTON ST
Second Line	:	SUITE 1300
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-2212
Country	:	US
Telephone Number	:	765-658-2700
Fax Number	:	765-658-2703

Provider Business Practice Location Address
First Line	:	1542 S BLOOMINGTON ST
Second Line	:	SUITE 1300
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-2212
Country	:	US
Telephone Number	:	765-658-2700
Fax Number	:	765-658-2703

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/31/2021

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