MEDICARE: DR. LISA MARIE COUGHLIN 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	208600000X	Surgery Physician	35-120363	OH
2	208600000X	Surgery Physician	4301506904	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	:	1932408622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE COUGHLIN M.D.

Provider Business Mailing Address
First Line	:	5640 N ADRIAN HWY # C
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-8318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5640 N ADRIAN HWY # C
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-8318
Country	:	US
Telephone Number	:	517-577-0283
Fax Number	:	517-577-0536

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	11/04/2025

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