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NPI Profile for Dr LISA M MCILVENNA in MIDLAND, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X |
| NPI Number | 1043412240 |
|
| Status | Active | |
| Credentials | DMIN | |
| Entity | Individual | |
| Enumeration date | 06/01/2007 | |
| Last updated | 01/18/2021 - About 5 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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LISA M MCILVENNA
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LISA M MCILVENNA, DMIN