Provider Demographics
NPI:1780683250
Name:BADDI, LISA LYNNE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNNE
Last Name:BADDI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25070 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1250
Mailing Address - Country:US
Mailing Address - Phone:847-585-7000
Mailing Address - Fax:847-240-9093
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:847-965-3200
Practice Address - Fax:847-965-3270
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104349207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363387138OtherTAX IDENTIFICATION NUMBER
IL363980044OtherTAX ID#
IL355030Medicare PIN
IL355030009Medicare PIN
IL363980044OtherTAX ID#
IL991370Medicare ID - Type Unspecified
IL632020007Medicare PIN
IL632020Medicare PIN
IL363387138OtherTAX IDENTIFICATION NUMBER
IL355031006Medicare PIN
IL355031Medicare PIN