Emm, Lisa R.

Emm, Lisa R. is an individual health care provider with primary practice located at 2304 Stern Dr , Bloomington IL 61704-4406. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Emm, Lisa R. can be contacted via phone (309) 663-0411.

Contact Information

Primary practice address
2304 Stern Dr Bloomington IL 61704-4406
Phone: (309) 663-0411
Fax: (309) 662-2018
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 036-115642 Illinois

Profile Details

NPI number 1386665966
LBN Legal business name Emm, Lisa R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2006
Last updated Nov 12th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386665966 NPPES
Illinois Other 216064 MEDICARE GROUP #
Illinois Other IL2613 MEDICARE GROUP #
Illinois MEDICAID 036115642 MEDICARE GROUP #

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