Individual
DR. LISA ERELIS RADIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3801 N HIGHWAY 19A STE 400, MOUNT DORA, FL 32757-2228
(352) 383-1245
(270) 887-8340
Mailing address
3801 N HIGHWAY 19A STE 400, MOUNT DORA, FL 32757-2228
(352) 383-1245
(270) 887-8340
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
32227
TN
207RN0300X
Nephrology Physician
3663
KY
207RN0300X
Nephrology Physician
Primary
ME104289
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000220426
ANTHEM
—
01
—
390008487
RAILROAD MEDICARE
—
05
—
64047830
—
KY
Enumeration date
08/01/2005
Last updated
09/26/2023
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