Provider Demographics
NPI:1386678415
Name:HORN-STINSON, LISA JEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JEAN
Last Name:HORN-STINSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:HORN CORRIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:11238 S. WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-233-0990
Mailing Address - Fax:773-233-0992
Practice Address - Street 1:11238 S. WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-233-0990
Practice Address - Fax:773-233-0992
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003946213E00000X
IN07000835A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003946Medicaid
ILT38839Medicare UPIN
IL6063370001Medicare NSC
IL215222Medicare PIN