Provider Demographics
NPI:1003901646
Name:BELLNER, LISA ANN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BELLNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-0580
Mailing Address - Country:US
Mailing Address - Phone:865-330-9799
Mailing Address - Fax:865-330-9759
Practice Address - Street 1:6441 DEANE HILL DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-330-9799
Practice Address - Fax:865-330-9759
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35462208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5623220001OtherPALMETTO
TN7152403OtherAETNA
TN41663670OtherHUMANA
TN0717787OtherCIGNA
TN4104038OtherBLUE CROSS/BLUE SHIELD
TN3871781Medicare PIN
TN1003901646Medicare PIN
TNF55785Medicare UPIN