Provider Demographics
NPI:1427029248
Name:ESTERLE, LISA M (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:ESTERLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:ESTERLE GRANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:234-271-3353
Mailing Address - Fax:330-725-6334
Practice Address - Street 1:3780 MEDINA RD STE 110
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9312
Practice Address - Country:US
Practice Address - Phone:234-360-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2127273Medicaid
OHG96950Medicare UPIN
OH2127273Medicaid