Provider Demographics
NPI:1043283179
Name:MILLER, LISA WILLIAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:WILLIAMS
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 BEECH DR.
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-331-8655
Mailing Address - Fax:859-341-7198
Practice Address - Street 1:108 BEECH DR.
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-8655
Practice Address - Fax:859-341-7198
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 05 3614208000000X
KY24589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1220582OtherUNITED HEALTH CARE OF OHI
KY64245897Medicaid
000000033740OtherANTHEM
0637329OtherAETNA
C69361Medicare UPIN