Individual
LISA A WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1205 HADLEY RD STE 130, MOORESVILLE, IN 46158-1934
(317) 831-9340
(317) 834-5768
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10000872A
IN
Other
Enumeration date
03/06/2007
Last updated
10/04/2023
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