Provider Demographics
NPI:1568457356
Name:BOBAY, LISA S (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:S
Last Name:BOBAY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3640 NEW VISION DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1717
Mailing Address - Country:US
Mailing Address - Phone:260-482-4440
Mailing Address - Fax:260-482-4442
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-4000
Practice Address - Fax:260-482-4442
Is Sole Proprietor?:No
Enumeration Date:2005-09-17
Last Update Date:2013-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10000360A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970022079Medicare ID - Type UnspecifiedRR MEDICARE
INS81563Medicare UPIN
IN047840DDDMedicare ID - Type Unspecified