Individual
LISA T FALOTICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10515 ILLINOIS RD, FORT WAYNE, IN 46814-9182
(260) 373-9200
(260) 373-9219
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003848A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
02003848A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201021560
—
IN
Enumeration date
07/07/2007
Last updated
10/20/2022
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