Individual
LISA C CAMPISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7926 PRESTON HWY, SUITE 106, LOUISVILLE, KY 40219-3848
(502) 964-4357
(502) 966-5948
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01045735A
IN
207R00000X
Internal Medicine Physician
27273
KY
208D00000X
General Practice Physician
Primary
01045735A
IN
208D00000X
General Practice Physician
27273
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000038150
ANTHEM
—
01
—
129355P
SIHO
—
05
—
200489100
—
IN
01
—
P00305257
RAILROAD MEDICARE
IN
01
—
P00838074
RAILROAD MEDICARE - NICC
KY
Enumeration date
04/20/2006
Last updated
10/26/2018
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