Individual
DR. LISA DEETTE STABER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20635 MISHAWAKA SHORES TRL, GRAND RAPIDS, MN 55744-6071
(218) 398-0256
Mailing address
20635 MISHAWAKA SHORES TRL, GRAND RAPIDS, MN 55744-6071
(218) 398-0256
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
38751-020
WI
207Q00000X
Family Medicine Physician
38751-20
WI
207Q00000X
Family Medicine Physician
Primary
38922
MN
207Q00000X
Family Medicine Physician
4301086765
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4848740
—
MI
01
—
P00328166
RR-MEDICARE
MI
01
—
P00328166
RR-MEDICARE
—
Enumeration date
04/27/2006
Last updated
05/09/2017
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