Individual
DR. LISA A DEBERNARDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
5108 HAMPTON AVE, SAINT LOUIS, MO 63109-3113
(314) 821-3668
(888) 966-0079
Mailing address
5108 HAMPTON AVE, SAINT LOUIS, MO 63109-3113
(314) 821-3668
(888) 966-0079
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016004789
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
2008030512
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004789
—
IL
05
—
1043219215
—
MO
01
—
1622982
BLUE CROSS / BLUE SHIELD
IL
01
—
480014516
RAILROAD MEDICARE
IL
01
—
P01302982
RAILROAD MEDICARE
MO
Enumeration date
07/19/2005
Last updated
12/21/2023
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