Provider Demographics
NPI:1912925843
Name:PANTHEL, LISA ALEXANDRA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ALEXANDRA
Last Name:PANTHEL
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:PO BOX 382257
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-2257
Mailing Address - Country:US
Mailing Address - Phone:205-623-0169
Mailing Address - Fax:205-623-0167
Practice Address - Street 1:5511 HIGHWAY 280
Practice Address - Street 2:STE 124
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6585
Practice Address - Country:US
Practice Address - Phone:205-623-0169
Practice Address - Fax:205-623-0167
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001049213E00000X, 213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA798702845BMedicaid
GAP00364374OtherRAILROAD MEDICARE
GAP00364374OtherRAILROAD MEDICARE
5243400001Medicare NSC
V06243Medicare UPIN