Distefano, Lisa G.

Distefano, Lisa G. is an individual health care provider with primary practice located at 2016 S Main St , Maryville MO 64468-2655. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Distefano, Lisa G. can be contacted via phone (660) 562-2525.

Contact Information

Primary practice address
2016 S Main St Maryville MO 64468-2655
Phone: (660) 562-2525
Fax: (660) 562-7993
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 119536 Missouri
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 119536 Missouri

Profile Details

NPI number 1003810789
LBN Legal business name Distefano, Lisa G.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2005
Last updated Nov 9th, 2012 - about 14 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 1003810789 NPPES
Iowa MEDICAID 0520171
Iowa MEDICAID 204665202

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