Individual
LISA SITZMANN PRUSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6351 E SUPERIOR ST, DULUTH, MN 55804-2545
(218) 249-5555
Mailing address
915 E 1ST ST, DULUTH, MN 55805-2107
(218) 249-5555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31997
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225090000
—
MN
05
—
31860000
—
WI
Enumeration date
07/14/2006
Last updated
06/15/2022
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