Individual
LISA K. RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18636 DIXIE HWY, HOMEWOOD, IL 60430-3741
(708) 647-0571
(708) 647-0676
Mailing address
1040 SIERRA DR, SUITE 400, GREENWOOD, IN 46143-7240
(317) 865-8988
(317) 859-8590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01068767A
IN
207Q00000X
Family Medicine Physician
036117734
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200999260
—
IN
05
—
20999260
—
IN
Enumeration date
05/08/2007
Last updated
12/10/2018
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