Provider Demographics
NPI:1689696437
Name:ZIEMNIK, LISA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUSAN
Last Name:ZIEMNIK
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:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:
Practice Address - Street 1:662 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9553
Practice Address - Country:US
Practice Address - Phone:937-641-5066
Practice Address - Fax:937-550-9797
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2598103Medicaid
OH2598103Medicaid
OHZI4192181Medicare PIN
OHI60706Medicare UPIN
OHZI4192182Medicare PIN
OH7598103Medicaid
OH2598103Medicaid
OH7363101Medicare PIN