Provider Demographics
NPI:1699116541
Name:LISA M. COLN MD APMC
Entity type:Organization
Organization Name:LISA M. COLN MD APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-889-7652
Mailing Address - Street 1:4770 S I 10 SERVICE RD W
Mailing Address - Street 2:SUITE 104
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1215
Mailing Address - Country:US
Mailing Address - Phone:504-889-7652
Mailing Address - Fax:504-889-7632
Practice Address - Street 1:4770 S I 10 SERVICE RD W
Practice Address - Street 2:SUITE 104
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1215
Practice Address - Country:US
Practice Address - Phone:504-889-7652
Practice Address - Fax:504-889-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD024744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1579297Medicaid