Tisa, Lee Michael

Tisa, Lee Michael is an sole proprietor health care provider with primary practice located at 502 Sue Ann Dr , Lake Geneva WI 53147-2341. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Tisa, Lee Michael can be contacted via phone (262) 248-9727.

Contact Information

Primary practice address
502 Sue Ann Dr Lake Geneva WI 53147-2341
Phone: (262) 248-9727
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016-003410 Illinois

Profile Details

NPI number 1184930745
LBN Legal business name Tisa, Lee Michael
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 20th, 2010
Last updated Aug 20th, 2010 - about 16 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 1184930745 NPPES
Illinois MEDICAID 016003410

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