Provider Demographics
NPI:1255439352
Name:KLEMEYER, LISA NORMAN (DPM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NORMAN
Last Name:KLEMEYER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5396 ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2447
Mailing Address - Country:US
Mailing Address - Phone:941-929-7903
Mailing Address - Fax:941-929-7903
Practice Address - Street 1:5537 MARQUESAS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3332
Practice Address - Country:US
Practice Address - Phone:941-379-8292
Practice Address - Fax:941-929-7903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2777213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U75794Medicare UPIN
FL65621Medicare ID - Type Unspecified
FL65621AMedicare ID - Type Unspecified
FL4518660001Medicare NSC