Provider Demographics
NPI:1225316219
Name:VANGEMERT, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:VANGEMERT
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 1:2550 UNIVERSITY AVE
Mailing Address - Street 2:APT 523
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE
Practice Address - Street 2:APT 523
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3830
Practice Address - Country:US
Practice Address - Phone:509-993-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60605207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine