| Doctor Name: | LISA KAREN DODGE |
| NPI Number: | 1245563196 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 3790-046 |
| Business Practice Address: | 571 75th St Clear Lake, WI - 540053819 |
| Business Phone Number: | 7152689006 |
| Business Fax Number: | |
| Mailing Address: | 571 75th St, CLEAR LAKE |
| State: | WI |
| Postal Code: | 540053819 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/10/2009 |
| NPI Last Update Date: | 09/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 305S00000X |
| License Number: | 3790-046 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Point of Service |
| Taxonomy Specialization: | |
| Taxonomy Definition: | This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |