Ide, Lisa

Ide, Lisa is an individual health care provider with primary practice located at 717 E River Pkwy , Minneapolis MN 55455-0369. She recently has only one registered license in Allopathic & Osteopathic Physicians / Occupational Medicine, which is considered as her primary health care specialty. Ide, Lisa can be contacted via phone (612) 436-4818.

Contact Information

Primary practice address
717 E River Pkwy Minneapolis MN 55455-0369
Phone: (612) 436-4818
Fax: (612) 436-2600
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Occupational Medicine 2083X0100X 34425 Minnesota

Profile Details

NPI number 1083702823
LBN Legal business name Ide, Lisa
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2006
Last updated Mar 7th, 2023 - about 3 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 1083702823 NPPES
Minnesota Other 34452 MEDICAL LICENSE

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