Provider Demographics
NPI:1811000284
Name:EVERT, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:EVERT
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 1:1004 SOUTH ROCK STREET
Mailing Address - Street 2:EASTER MEDICAL STAFFING
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626
Mailing Address - Country:US
Mailing Address - Phone:512-374-1876
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087953207L00000X, 207LA0401X, 207LC0200X, 207LH0002X, 207LP2900X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000541269OtherANTHEM
OH0583328OtherBCMH
OH363600OtherWELLCARE MEDICAID
OH7839837OtherAETNA
OH000000221395OtherUNISON
MI1811000284OtherMICHIGAN MEDICAID
OHP00400485OtherMEDICARE RAILROAD
OH746258OtherBUCKEYE MEDICAID
OH2681012Medicaid
OHP00400485OtherMEDICARE RAILROAD
OH7839837OtherAETNA