Provider Demographics
NPI:1932109964
Name:RADIX, LISA ERELIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ERELIS
Last Name:RADIX
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 1:3801 N HIGHWAY 19A STE 400
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2228
Mailing Address - Country:US
Mailing Address - Phone:352-383-1245
Mailing Address - Fax:270-887-8340
Practice Address - Street 1:3801 N HIGHWAY 19A STE 400
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2228
Practice Address - Country:US
Practice Address - Phone:352-383-1245
Practice Address - Fax:270-887-8340
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3663207RN0300X
TN32227207RN0300X
FLME104289207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64047830Medicaid
390008487OtherRAILROAD MEDICARE
000000220426OtherANTHEM
000000220426OtherANTHEM
390008487OtherRAILROAD MEDICARE