Provider Demographics
NPI:1760431084
Name:OLIVERI-LEPAIN, LISA J (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:OLIVERI-LEPAIN
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-3102
Mailing Address - Fax:517-353-3101
Practice Address - Street 1:4660 S HAGADORN RD STE 230
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5353
Practice Address - Country:US
Practice Address - Phone:517-353-3102
Practice Address - Fax:517-353-3101
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013082207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760431084Medicaid
P01104787OtherRR MEDICARE
MIH65153Medicare UPIN
MI1760431084Medicaid