Individual
DR. LISA MARIE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
520 W MELROSE ST APT 3H, CHICAGO, IL 60657-3790
(248) 563-7744
Mailing address
520 W MELROSE ST APT 3H, CHICAGO, IL 60657-3790
(248) 563-7744
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
125.079920
IL
Other
Enumeration date
04/07/2022
Last updated
06/03/2022
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