Provider Demographics
NPI:1851315188
Name:KIRSCH, LISA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:FRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BLDG 2108, STE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8029
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:2346 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1329
Practice Address - Country:US
Practice Address - Phone:602-282-0078
Practice Address - Fax:602-282-0102
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26909208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF49027Medicare UPIN