Provider Demographics
NPI:1124228010
Name:CLAY, LISA RENEE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:CLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:90 EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2612
Mailing Address - Country:US
Mailing Address - Phone:317-804-4203
Mailing Address - Fax:317-564-0627
Practice Address - Street 1:90 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2612
Practice Address - Country:US
Practice Address - Phone:317-804-4203
Practice Address - Fax:317-564-0627
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065883A208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200931520AMedicaid
IN203170WWWWMedicare PIN