Staber, Lisa Deette

Staber, Lisa Deette is an sole proprietor health care provider with primary practice located at 20635 Mishawaka Shores Trl , Grand Rapids MN 55744-6071. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Staber, Lisa Deette can be contacted via phone (218) 398-0256.

Contact Information

Primary practice address
20635 Mishawaka Shores Trl Grand Rapids MN 55744-6071
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4301086765 Michigan
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 38751-020 Wisconsin
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 38922 Minnesota
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 38751-20 Wisconsin

Profile Details

NPI number 1629035308
LBN Legal business name Staber, Lisa Deette
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 27th, 2006
Last updated May 9th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629035308 NPPES
Michigan MEDICAID 4848740
Michigan Other P00328166
Michigan Other P00328166

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