Provider Demographics
NPI:1942645288
Name:BLOCK, LISA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BLOCK
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:UW HOSPITAL AND CLINICS
Mailing Address - Street 2:600 HIGHLAND AVE, H4/831
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-3284
Mailing Address - Country:US
Mailing Address - Phone:608-263-1367
Mailing Address - Fax:
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 330
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-203-7110
Practice Address - Fax:970-203-7098
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI639192086S0122X
CODR.00641842086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery