Provider Demographics
NPI:1407832884
Name:FAIA, LISA JANE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:FAIA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:39650 ORCHARD HILL PL
Mailing Address - Street 2:200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-319-0161
Mailing Address - Fax:248-319-0170
Practice Address - Street 1:3555 W 13 MILE RD
Practice Address - Street 2:LL-20
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-288-2280
Practice Address - Fax:248-288-5644
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-01-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301093666207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407832884Medicaid
MIQ26082045Medicare PIN
I09234Medicare UPIN
MIM21980027Medicare PIN