Provider Demographics
NPI:1700132537
Name:LISTER, LINDA LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEWIS
Last Name:LISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 WATERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1158
Mailing Address - Country:US
Mailing Address - Phone:317-345-6348
Mailing Address - Fax:
Practice Address - Street 1:6319 E US HIGHWAY 36
Practice Address - Street 2:SUITE 4
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6209
Practice Address - Country:US
Practice Address - Phone:317-345-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028295A207L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine