Provider Demographics
NPI:1700856937
Name:SCHOMOGYI, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SCHOMOGYI
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 1:10351 DAWSONS CREEK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1904
Mailing Address - Country:US
Mailing Address - Phone:260-969-1950
Mailing Address - Fax:260-969-0988
Practice Address - Street 1:2510 E DUPONT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1600
Practice Address - Country:US
Practice Address - Phone:260-969-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049376A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00326116OtherRAILROAD MEDICARE
IN200190090Medicaid
203267938OtherINDIANA HEALTH NETWORK
000000031417OtherMPLAN PARKVIEW
0670165OtherCIGNA
IN000000379760OtherANTHEM
9689OtherPHYSICIANS HEALTH PLAN
IN200190090Medicaid
INP00326116Medicare PIN
000000031417OtherMPLAN PARKVIEW
IN000000379760OtherANTHEM