Provider Demographics
NPI:1144259623
Name:LANHAM, LISA R (DPM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:LANHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8558
Mailing Address - Country:US
Mailing Address - Phone:812-376-9353
Mailing Address - Fax:812-376-3757
Practice Address - Street 1:4665 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8558
Practice Address - Country:US
Practice Address - Phone:812-376-9353
Practice Address - Fax:812-376-3757
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000752A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000195454OtherANTHEM
IN200126100Medicaid
IN003954OtherSIHO
IN000000195454OtherANTHEM
IN003954OtherSIHO
IN179910AMedicare PIN