Provider Demographics
NPI:1306842414
Name:RICHTER, LISA M (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RICHTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-7584
Mailing Address - Fax:317-957-2705
Practice Address - Street 1:1011 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6978
Practice Address - Country:US
Practice Address - Phone:317-957-9150
Practice Address - Fax:317-957-9965
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02002515A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200414080Medicaid
INP01456957OtherRAIL ROAD PTAN
IN000000228239OtherBLUE CROSS BLUE SHIELD
IN266180474Medicare PIN
IN000000228239OtherBLUE CROSS BLUE SHIELD