DR. LEE MICHAEL TISA D.P.M. NPI 1184930745

NPI Information

NPI: 1184930745
Provider Name: DR. LEE MICHAEL TISA, D.P.M.
Classification: Podiatrist - 213E00000X
Entity Type: Individual
Address:
502 SUE ANN DR
LAKE GENEVA, WI
ZIP 53147
Phone: (262) 248-9727
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DR. Lee Michael Tisa, D.P.M. is a podiatrist in Lake Geneva, WI. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. DR. Lee Michael Tisa, D.P.M. NPI is 1184930745. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

502 SUE ANN DR
LAKE GENEVA, WI
ZIP 53147-341
Phone: (262) 248-9727

The enumeration date for this NPI number is 8/20/2010 and was last updated on 8/20/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213E00000X	Podiatrist		016-003410	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	T37883	MEDICARE UPIN	ILLINOIS
2	016003410	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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