Provider Demographics
NPI:1073691325
Name:SOLDAT, LISA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:SOLDAT
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 1:1801 HICKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1957
Mailing Address - Country:US
Mailing Address - Phone:515-282-2200
Mailing Address - Fax:
Practice Address - Street 1:1801 HICKMAN ROAD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1957
Practice Address - Country:US
Practice Address - Phone:515-282-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA243076OtherMIDLANDS CHOICE
IA16933OtherWELLMARK OF IOWA
IAIA0181OtherJOHN DEERE
IA430587Medicaid
IA71815OtherWELLMARK BCBS
IA16933OtherWELLMARK OF IOWA
IA71815OtherWELLMARK BCBS
IA430587Medicaid
IAI11167Medicare ID - Type Unspecified