Individual
LISA DENISE MULLALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11275 DELAWARE PKWY, CROWN POINT, IN 46307-7812
(219) 779-8735
(877) 715-2312
Mailing address
PO BOX 108, CROWN POINT, IN 46308-0108
(219) 779-8735
(877) 715-2312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003098
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000721919
ANTHEM TRADITIONAL
IN
05
—
200833870
—
IN
Enumeration date
01/23/2006
Last updated
03/25/2019
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