Provider Demographics
NPI:1245207695
Name:HUGHES, LISA A (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2513 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5325
Mailing Address - Country:US
Mailing Address - Phone:231-935-6080
Mailing Address - Fax:231-935-6081
Practice Address - Street 1:217 S MADISON STREET
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2320
Practice Address - Country:US
Practice Address - Phone:231-392-8400
Practice Address - Fax:231-935-7888
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI011303207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3363824Medicaid
MILH011303OtherBLUE CROSS LICENSE STATE
MI115800635OtherRR MEDICARE
MI6408244OtherCIGNA
MI115800635OtherRR MEDICARE
MIG55771Medicare UPIN