Raderstorf, Lisa D

Raderstorf, Lisa D is an individual health care provider with primary practice located at 5838 W Brick Rd Suite 106, South Bend IN 46628-8423. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Raderstorf, Lisa D can be contacted via phone (574) 247-1911.

Contact Information

Primary practice address
5838 W Brick Rd Suite 106 South Bend IN 46628-8423
Phone: (574) 247-1911
Fax: (574) 247-1912
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10000915A Indiana

Profile Details

NPI number 1245421031
LBN Legal business name Raderstorf, Lisa D
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 6th, 2007
Last updated Dec 2nd, 2011 - about 15 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 1245421031 NPPES
Indiana Other 000000527324 ANTHEM BLUE CROSS

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