Individual
MS. LISA C DEZELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9200 W WISCONSIN AVE, DIVISION OF NEOPLASTIC DISEASES, MILWAUKEE, WI 53226-3522
(414) 805-6800
(414) 805-6805
Mailing address
9200 W WISCONSIN AVE, DIVISION OF NEOPLASTIC DISEASES, MILWAUKEE, WI 53226-3522
(414) 805-6800
(414) 805-6805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1458
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005000261H
HUMANA
—
05
—
1063466373
—
WI
Enumeration date
05/20/2006
Last updated
12/13/2012
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