Provider Demographics
NPI:1518056951
Name:POCIUS, LISA C (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:POCIUS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1735
Mailing Address - Country:US
Mailing Address - Phone:630-252-2088
Mailing Address - Fax:630-252-6615
Practice Address - Street 1:9700 S CASS AVE BLDG 201
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4801
Practice Address - Country:US
Practice Address - Phone:630-252-2088
Practice Address - Fax:630-252-6615
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109833Medicaid
IL920540OtherMEDICARE PTAN (GROUP)
ILP01144139OtherRAILROAD MEDICARE INDIVIDUAL PTAN
IL920540031OtherMEDICARE PTAN (INDIVIDUAL)
ILP01144139OtherRAILROAD MEDICARE INDIVIDUAL PTAN
IL920540OtherMEDICARE PTAN (GROUP)