Provider Demographics
NPI:1053597674
Name:USDAN, LISA SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUZANNE
Last Name:USDAN
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 1:6401 POPLAR AVE, SUITE 420
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-843-1045
Mailing Address - Fax:901-843-1206
Practice Address - Street 1:6401 POPLAR AVE, SUITE 420
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-843-1045
Practice Address - Fax:901-843-1206
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234654207R00000X
TN43169207RE0101X, 207R00000X
TN0000043169207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine