Individual
KATHERINE LISONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Mailing address
2401 VALLEY DR, VALPARAISO, IN 46383-2520
(219) 413-5100
(219) 465-9502
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11011690
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000580326
BCBS
IN
05
—
200844990
—
IN
Enumeration date
07/17/2006
Last updated
02/18/2021
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