Provider Demographics
NPI:1144280892
Name:PALLINI, LISA ANN (DPM)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:PALLINI
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 1:16601N 40TH ST 118
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3355
Mailing Address - Country:US
Mailing Address - Phone:781-572-2313
Mailing Address - Fax:602-753-9453
Practice Address - Street 1:4921E BELL RD 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-753-9043
Practice Address - Fax:602-753-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2213213E00000X, 213ES0131X
AZ0701213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAYY7152OtherBCBS
MA91252OtherFALLON COMMUNITY HP
MA469746OtherTUFTS HP
MAAA17218OtherHARVARD PILGRIM HEALTHCAR
MANEIGHBORHOOD HPOther0033412
MAPAY75146Medicare ID - Type Unspecified
MAYY7152OtherBCBS
MA91252OtherFALLON COMMUNITY HP