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
Phone: (218) 398-0256
Fax:
Website:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1629035308 | NPPES |
Michigan | MEDICAID | 4848740 | |
Michigan | Other | P00328166 | |
Michigan | Other | P00328166 |
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