Provider Demographics
NPI:1053790113
Name:HAN, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAN
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 1:5841 S. MARYLAND AVE., RM. S323, MC 3083
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1470
Mailing Address - Country:US
Mailing Address - Phone:773-834-8376
Mailing Address - Fax:773-702-1119
Practice Address - Street 1:5841 S. MARYLAND AVE., RM. S323, MC 3083
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1470
Practice Address - Country:US
Practice Address - Phone:773-834-8376
Practice Address - Fax:773-702-1119
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066232207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology