Provider Demographics
NPI:1689787566
Name:FINKELSTEIN, LISA J (DO FACOS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:FINKELSTEIN
Suffix:
Gender:F
Credentials:DO FACOS
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 428
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0428
Mailing Address - Country:US
Mailing Address - Phone:077-397-6903
Mailing Address - Fax:307-739-7644
Practice Address - Street 1:555 E BROADWAY AVE STE 229
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:307-739-7690
Practice Address - Fax:307-739-7644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6840 A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118828300Medicaid
WY10329Medicare PIN
WY118828300Medicaid
F71233Medicare UPIN