Individual
DR. LISA M MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6050 STERLING CREEK RD, PORTAGE, IN 46368-7752
(219) 763-8112
(219) 764-5380
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036091949
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091949
—
IL
Enumeration date
11/23/2005
Last updated
08/13/2020
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