Provider Demographics
NPI:1376658500
Name:ZAPOTOCKY, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:ZAPOTOCKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:C
Other - Last Name:ALLSHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9485 MENTOR AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-205-5877
Mailing Address - Fax:440-205-5735
Practice Address - Street 1:9485 MENTOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-205-5877
Practice Address - Fax:440-205-5744
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081768207RA0000X
OH35.081768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2352350Medicaid
OH2352350Medicaid