Individual
LISA R WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8200
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51324
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34993000
—
WI
01
—
P00751666
MEDICARE RAILROAD
WI
Enumeration date
10/17/2007
Last updated
12/02/2020
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