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Individual

DR. RAUFU ADEFEMI LASISI

Active
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Individual

DR. RAUFU ADEFEMI LASISI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11013709A
IN
208M00000X
Hospitalist Physician
Primary
01067846A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000672592
HPN ANTHEM PIN#
—
01
—
000000708549
ANTHEM PROVIDER NUMBER / TIN 35-2030653
IN
01
—
200311740H
HPN MEDICAID GROUP#/LOCATION
IN
05
—
200980210
—
IN
01
—
205110
HPN MEDICARE GROUP#
—
Enumeration date
06/02/2008
Last updated
03/04/2014
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