Provider Demographics
NPI:1376532879
Name:LISA LARKIN, MD,LLC
Entity Type:Organization
Organization Name:LISA LARKIN, MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-271-5111
Mailing Address - Street 1:1315 SOLUTIONS CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1003
Mailing Address - Country:US
Mailing Address - Phone:513-421-3504
Mailing Address - Fax:513-231-7055
Practice Address - Street 1:4460 RED BANK EXPY
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1548
Practice Address - Country:US
Practice Address - Phone:513-271-5111
Practice Address - Fax:513-272-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333719Medicaid
KY65937351Medicaid
OHCK3758OtherRR MCR
OH9324871Medicare PIN