Provider Demographics
NPI:1578523155
Name:GREISING, LISA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:GREISING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-665-7515
Mailing Address - Fax:773-665-7514
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-665-7515
Practice Address - Fax:773-665-7514
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG53483Medicare UPIN
IL569490Medicare ID - Type Unspecified