Provider Demographics
NPI:1013172121
Name:MALYS, LISA A (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:MALYS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3477 COMMERCE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7126
Mailing Address - Country:US
Mailing Address - Phone:330-601-0999
Mailing Address - Fax:330-601-0935
Practice Address - Street 1:3477 COMMERCE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7126
Practice Address - Country:US
Practice Address - Phone:330-601-0999
Practice Address - Fax:330-601-0935
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014900207Q00000X, 207QG0300X
OH34011290207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104063Medicaid
OH0104063Medicaid