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Individual

LISA CONSTANCE BUENGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3605 MAYFAIR AVE, HIBBING, MN 55746-2935
(218) 262-3441
(218) 362-6170
Mailing address
3605 MAYFAIR AVE, HIBBING, MN 55746-2935
(218) 262-3441
(218) 362-6170

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
43611
MN
208000000X
Pediatrics Physician
45789
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
203743000
TAX IDENTIFACTION NUMBER
WI
05
344453000
WI
Enumeration date
08/15/2006
Last updated
02/22/2017
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