Individual
DR. LISA CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 W 49TH ST, AUSTIN, TX 78756-3101
(512) 776-6309
Mailing address
1100 W 49TH ST, AUSTIN, TX 78756-3101
(512) 776-6309
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
L6844
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1596207-01
—
TX
01
—
1596207-02
CSHCN
TX
05
—
159620703
—
TX
01
—
8J0636
BLUE SHIELD
TX
01
—
P00047686
RR/MEDICARE
TX
Enumeration date
03/24/2006
Last updated
10/28/2014
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