Individual
LISA DIANE WAITCHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5454 HOHMAN AVE, HAMMOND, IN 46320-1931
(219) 933-2077
(219) 864-2649
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2649
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02002745A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200486900
—
IN
01
—
90001358
BCBSIL
IL
Enumeration date
08/30/2005
Last updated
07/20/2011
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