Organization
LISA OLDHAM MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA MARIE OLDHAM MD (PHYSICIAN)
(312) 942-0099
Entity
Organization
Contact information
Practice address
1300 W BELMONT AVE, SUITE 10, CHICAGO, IL 60657-3200
(312) 942-0099
(773) 880-2321
Mailing address
1300 W BELMONT AVE, SUITE 10, CHICAGO, IL 60657-3200
(312) 942-0099
(773) 880-2321
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036105494
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105494
—
IL
01
—
1689636904
NPI
IL
Enumeration date
11/15/2006
Last updated
05/27/2014
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