Individual
LISA RENEE VANTREASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2145 N FAIRFIELD RD STE 100, BEAVERCREEK, OH 45431
(937) 558-3900
(937) 558-3999
Mailing address
2145 N FAIRFIELD RD STE 100, BEAVERCREEK, OH 45431-2783
(937) 558-3900
(937) 558-3999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-075877
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2159373
—
OH
Enumeration date
06/06/2006
Last updated
11/17/2020
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