Provider Demographics
NPI:1972628162
Name:PALMER, LISA C (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:PALMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2060 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5622
Mailing Address - Country:US
Mailing Address - Phone:920-965-0606
Mailing Address - Fax:920-965-0607
Practice Address - Street 1:2060 BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5622
Practice Address - Country:US
Practice Address - Phone:920-965-0606
Practice Address - Fax:920-965-0607
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI631832080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008325Medicaid
H99208Medicare UPIN
WV3810008325Medicaid