Individual
LISA D. STAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2421
(313) 916-9102
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2421
(313) 916-9102
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101012063
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
5101012063
MI
207RP1001X
Pulmonary Disease Physician
Primary
5101012063
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290H264420
BLUE CROSS-BLUE CROSS
—
05
—
336313611
—
MI
01
—
LS012063
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
12/01/2006
Last updated
10/16/2013
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