Provider Demographics
NPI:1184764037
Name:MUSOLIN, LISA MICHELE (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELE
Last Name:MUSOLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2146 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3096
Mailing Address - Country:US
Mailing Address - Phone:740-432-1963
Mailing Address - Fax:740-432-5143
Practice Address - Street 1:2146 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3096
Practice Address - Country:US
Practice Address - Phone:740-432-1963
Practice Address - Fax:740-432-5143
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV2078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine