MEDICARE: DR. LISA ALEXANDRA PANTHEL D.P.M

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	213E00000X	Podiatrist	POD001049	GA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	POD001049	GA
3	213ES0131X	Foot Surgery Podiatrist	POD001049	GA
4	213EP1101X	Primary Podiatric Medicine Podiatrist	POD001049	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00364374	OTHER	GA	RAILROAD MEDICARE

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	:	1912925843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ALEXANDRA PANTHEL D.P.M

Provider Business Mailing Address
First Line	:	PO BOX 382257
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35238-2257
Country	:	US
Telephone Number	:	205-623-0169
Fax Number	:	205-623-0167

Provider Business Practice Location Address
First Line	:	5511 HIGHWAY 280
Second Line	:	STE 124
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-6585
Country	:	US
Telephone Number	:	205-623-0169
Fax Number	:	205-623-0167

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/09/2014

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Directions to “ DR. LISA ALEXANDRA PANTHEL D.P.M” Practice Location

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