Provider Demographics
NPI:1023082500
Name:CHILDERS, LISA S (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8330 NAAB RD
Mailing Address - Street 2:STE. 135
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5925
Mailing Address - Country:US
Mailing Address - Phone:317-872-2479
Mailing Address - Fax:317-872-5264
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:STE. 135
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-872-2479
Practice Address - Fax:317-872-5264
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01026208A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN898190H7Medicare ID - Type Unspecified
IN898230BMedicare ID - Type Unspecified
INE44999Medicare UPIN