Provider Demographics
NPI:1750384277
Name:HEINEMEYER-FOSTER, LISA K (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:HEINEMEYER-FOSTER
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 1:68 DARST RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3442
Mailing Address - Country:US
Mailing Address - Phone:937-531-0132
Mailing Address - Fax:937-531-0134
Practice Address - Street 1:68 DARST RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3442
Practice Address - Country:US
Practice Address - Phone:937-531-0132
Practice Address - Fax:937-531-0134
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064298H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080191706OtherRAILROAD MEDICARE
OH35064298OtherMEDICAL LICENSE
OH421534506079OtherCARESOURCE
OH638336OtherAETNA
OH24260OtherNATIONWIDE HEALTH PLAN
OH000000227880OtherANTHEM
OH0122513OtherUNITE HEALTH CARE
OH281697850007OtherMEDICAL MUTUAL OF OHIO
OH0980881Medicaid
OHD64298OtherHUMANA/CHOICECARE
OH638336OtherAETNA
OH0122513OtherUNITE HEALTH CARE
OHHE0745643Medicare PIN