Provider Demographics
NPI:1003904566
Name:AEMMER, LYSA MARLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYSA
Middle Name:MARLEEN
Last Name:AEMMER
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 1:2213 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1402
Mailing Address - Country:US
Mailing Address - Phone:419-251-2415
Mailing Address - Fax:
Practice Address - Street 1:2213 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1402
Practice Address - Country:US
Practice Address - Phone:419-251-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3112643Medicaid
OH3112643Medicaid