Provider Demographics
NPI:1003816646
Name:MICHAELS, LISA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1593 MCDANIEL DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-7039
Mailing Address - Country:US
Mailing Address - Phone:610-431-0200
Mailing Address - Fax:610-431-9333
Practice Address - Street 1:1593 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-7039
Practice Address - Country:US
Practice Address - Phone:610-431-0200
Practice Address - Fax:610-431-9333
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000173213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034829Medicaid
DE0000600450Medicaid
DEV00935Medicare UPIN
DE014654T50Medicare ID - Type UnspecifiedINDIVIDUAL
DE1000034829Medicaid