Basic Information
| Provider Information | |||||||||
| NPI: | 1750384277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINEMEYER-FOSTER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 DARST RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375310132 | ||||||||
| FaxNumber: | 9375310134 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 DARST RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375310132 | ||||||||
| FaxNumber: | 9375310134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2005 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35064298H | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080191706 | 01 | OH | RAILROAD MEDICARE | OTHER | 35064298 | 01 | OH | MEDICAL LICENSE | OTHER | 421534506079 | 01 | OH | CARESOURCE | OTHER | 638336 | 01 | OH | AETNA | OTHER | 24260 | 01 | OH | NATIONWIDE HEALTH PLAN | OTHER | 000000227880 | 01 | OH | ANTHEM | OTHER | 0122513 | 01 | OH | UNITE HEALTH CARE | OTHER | 281697850007 | 01 | OH | MEDICAL MUTUAL OF OHIO | OTHER | 0980881 | 05 | OH | MEDICAID | D64298 | 01 | OH | HUMANA/CHOICECARE | OTHER |