Individual
DR. LISA RUTH WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3931 LOUISIANA AVE S, SUITE 400E, ST LOUIS PARK, MN 55426-5000
(952) 993-3232
Mailing address
3931 LOUISIANA AVE S, SUITE 400E, ST LOUIS PARK, MN 55426-5000
(952) 993-3232
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
47293
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0902076
MEDICA PROV #
MN
01
—
1042879
PREFERRED ONE ID
MN
01
—
182P7WA
BLUECROSS BLUE SHIELD
MN
01
—
2371982
AMERICA'S PPO
MN
05
—
382154400
—
MN
01
—
HP48036
HEALTH PARTNERS
MN
Enumeration date
04/05/2006
Last updated
03/21/2014
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