Provider Demographics
NPI:1356337273
Name:MENZIES, LISA J (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:MENZIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1453
Mailing Address - Country:US
Mailing Address - Phone:515-241-8923
Mailing Address - Fax:515-241-5127
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1453
Practice Address - Country:US
Practice Address - Phone:515-241-8923
Practice Address - Fax:515-241-5127
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA29701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0109306Medicaid
175150070OtherMEDICARE
IA1356337273Medicaid
175150070OtherMEDICARE