Individual
MS. LISA D RADERSTORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
52500 FIR RD, GRANGER, IN 46530-8579
(574) 271-0700
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 234-8161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006281
MI
Other
Enumeration date
08/06/2007
Last updated
07/14/2025
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