Provider Demographics
NPI:1578652376
Name:CONTI, LISA (MD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:CONTI
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 1:5927 CENTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9196
Mailing Address - Country:US
Mailing Address - Phone:502-241-3934
Mailing Address - Fax:502-222-8647
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-3886
Practice Address - Fax:502-222-8647
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25877207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1143378Medicaid
KY64258775Medicaid
KY000000194123OtherKY ANTHEM #--GLAS
KY0663608Medicare ID - Type UnspecifiedKY MCR #--GLAS
KYE84246Medicare UPIN
KY2438168000Medicare ID - Type UnspecifiedKY MCR HMO #--GLAS