MEDICARE: DR. LISA J PERKOWSKI MD P.C.

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	207R00000X	Internal Medicine Physician	89-276	NM

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	:	1831187921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA J PERKOWSKI MD P.C.

Provider Business Mailing Address
First Line	:	PO BOX 3174
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88221-3174
Country	:	US
Telephone Number	:	575-302-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-3513
Country	:	US
Telephone Number	:	575-887-1282
Fax Number	:	575-885-9923

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	02/08/2013

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