| Drlullaby Llc | |
|
4380 67th Dr # 1033 Union Grove WI 53182-9338 | |
| (844) 475-3379 | |
| (855) 644-2985 |
| Full Name | Drlullaby Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4380 67th Dr # 1033, Union Grove, Wisconsin |
| Authorized Official Name and Position | Lisa Ann Medalie (CEO) |
| Authorized Official Contact | 6199975759 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drlullaby Llc 1440 W Taylor St # 556 Chicago IL 60607-4623 Ph: (844) 475-3379 | Drlullaby Llc 4380 67th Dr # 1033 Union Grove WI 53182-9338 Ph: (844) 475-3379 |
| NPI Number | 1003520149 |
|---|---|
| Provider Enumeration Date | 01/12/2023 |
| Last Update Date | 03/14/2023 |
| Certification Date | 03/14/2023 |
| Medicare PECOS PAC ID | 9931507290 |
|---|---|
| Medicare Enrollment ID | O20230427002977 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003520149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lisa Medalie |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1609175744 PECOS PAC ID: 7315122520 Enrollment ID: I20230427002997 |
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