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Individual

LISA FAYE CLUNIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1995 EDSEL LN NW, SUITE 3, CORYDON, IN 47112-3008
(812) 738-4915
(812) 734-1365
Mailing address
PO BOX 38, CORYDON, IN 47112-0038
(812) 738-8763
(812) 738-7833

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01058900A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000345157
ANTHEM
IN
05
200487550
IN
Enumeration date
10/11/2005
Last updated
07/18/2022
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