Lisa Kochanik, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

76051-20 Issued in WI

Practice address

2529 W Glenbrook LN
Mequon, WI 53092-3148

Phone

(262) 202-2329

NPI assigned

May 1, 2007

Last updated

Mar 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Lisa Stephanie Gall Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647043200000",
    "number": "1780805366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2529 W GLENBROOK LN",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923148",
            "telephone_number": "262-202-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2529 W GLENBROOK LN",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923148",
            "telephone_number": "262-202-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCHANIK",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0065578",
            "primary": false
        },
        {
            "code": "2080B0002X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Obesity Medicine",
            "state": "WI",
            "license": "76051-20",
            "primary": false
        },
        {
            "code": "2080H0002X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Hospice and Palliative Medicine",
            "state": "WI",
            "license": "76051-20",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "76051-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "GALL",
            "middle_name": "STEPHANIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephan William Klug, DDS
• Michael John Knabel
• Michael Kerry Knight, PT, DPT
• Maximilian Nathan Knoell II
• Dennis Lee Kochanik, NURSE PRACTITIONER
• Tracy Lynn Koltun, RN
• Mark J Kortebein, DDS
• Madhumathi Kosaraju, MD
• Kathryn J Kostic, MD
• Kristen Kotecki

• Pediatrics Physician in Mequon, WI
• Providers in Mequon, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.