Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 4301085936 | MI |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A112336 | CA |
NPI | 1962611277 |
---|---|
Provider Name | Dr. Lisa Dawn Maskill |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 03/03/2021 |