Provider Demographics
NPI:1578510509
Name:SUFFIAN, LISA V (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:V
Last Name:SUFFIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:C B 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2694
Mailing Address - Fax:314-454-2515
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2694
Practice Address - Fax:314-454-2515
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1108602080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103810122Medicaid
IL$$$$$$$$$Medicaid
MO103810122Medicare PIN
H40589Medicare UPIN
IL$$$$$$$$$Medicaid