Provider Demographics
NPI:1104115468
Name:DAVIDOFF, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAVIDOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PEARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:707 LAKE COOK RD STE 122
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4909
Mailing Address - Country:US
Mailing Address - Phone:224-296-1520
Mailing Address - Fax:224-252-6330
Practice Address - Street 1:707 LAKE COOK RD STE 122
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4909
Practice Address - Country:US
Practice Address - Phone:224-296-1520
Practice Address - Fax:224-252-6330
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.138311208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics