Provider Demographics
NPI:1982843769
Name:LISA MEDWEDEFF M.D. PA
Entity Type:Organization
Organization Name:LISA MEDWEDEFF M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEDWEDEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:972-608-3333
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-608-3333
Mailing Address - Fax:972-473-7333
Practice Address - Street 1:5425 W SPRING CREEK PKWY
Practice Address - Street 2:STE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4236
Practice Address - Country:US
Practice Address - Phone:972-608-3333
Practice Address - Fax:972-473-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty