Individual
MARA LAUREN LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14001 RIDGEDALE DR, SUITE 100, MINNETONKA, MN 55305-1753
(952) 473-0211
Mailing address
4370 BROWNDALE AVE, ST LOUIS PARK, MN 55424-1012
(763) 234-6632
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
53077
MN
Other
Enumeration date
08/14/2007
Last updated
03/30/2017
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