Provider Demographics
NPI:1154586790
Name:ALLEN, LISA LEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LEANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ALLOUEZ AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6280
Mailing Address - Country:US
Mailing Address - Phone:920-228-2274
Mailing Address - Fax:
Practice Address - Street 1:1808 ALLOUEZ AVE STE C
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6280
Practice Address - Country:US
Practice Address - Phone:920-228-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2910207Q00000X
WI55644-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI430800041Medicare Oscar/Certification
WI070280369Medicare Oscar/Certification