Provider Demographics
NPI:1083691117
Name:KURTZ, LISA HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:HARRIS
Last Name:KURTZ
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 1:13550 FALLING WATER RD
Mailing Address - Street 2:STE 101
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-4360
Mailing Address - Country:US
Mailing Address - Phone:440-878-8787
Mailing Address - Fax:440-878-8786
Practice Address - Street 1:13550 FALLING WATER RD
Practice Address - Street 2:STE 101
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-4360
Practice Address - Country:US
Practice Address - Phone:440-878-8787
Practice Address - Fax:440-878-8786
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350847682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7308150OtherAETNA
OH1984176OtherUNITED HEALTH CARE
OH000000345757OtherANTHEM
OHH24176Medicare UPIN
OH7308150OtherAETNA
OH1984176OtherUNITED HEALTH CARE