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Individual

DR. LISA MARIE RICHMOND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
8111 TOWNSHIP LINE RD, INDIANAPOLIS, IN 46260-2479
(317) 415-7921
Mailing address
8840 COMMERCE PARK PL STE E, INDIANAPOLIS, IN 46268-3129

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01064992A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01064992A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000570502
ANTHEM
IN
Enumeration date
07/23/2007
Last updated
12/10/2015
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