Provider Demographics
NPI:1518931195
Name:RICH, LISA MATUSZEWSKI (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MATUSZEWSKI
Last Name:RICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2514 S 102ND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2142
Mailing Address - Country:US
Mailing Address - Phone:414-259-8917
Mailing Address - Fax:414-777-5210
Practice Address - Street 1:601 N 99TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4339
Practice Address - Country:US
Practice Address - Phone:414-431-2186
Practice Address - Fax:414-431-9619
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2022-01-28
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Provider Licenses
StateLicense IDTaxonomies
WI30615207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518931195Medicaid
000501079Medicare PIN
WIWI1897125Medicare PIN
WIE60576Medicare UPIN