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Dr. Lisa Deette Staber, MD
Family Medicine Physician in Grand Rapids, Minnesota
NPI 1629035308

Lisa Deette Staber is a Family Medicine Physician based in Grand Rapids, MN. Lisa Deette Staber practices in Grand Rapids, MN and has the professional credentials of MD. The NPI Number for Lisa Deette Staber is 1629035308 and holds a License No. 4301086765 (Minnesota).

The current practice location address for Lisa Deette Staber is 20635 Mishawaka Shores Trl, Grand Rapids, MN and can be reached out via phone at 218-398-0256.

Location: 20635 Mishawaka Shores Trl, Grand Rapids, MN, 55744-6071
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1629035308
Provider Name
Lisa Deette Staber
Credential
MD
Provider Entity Type
Individual
Gender
Female
Address
20635 Mishawaka Shores Trl, Grand Rapids, MN, 55744-6071
Phone Number
218-398-0256
Fax Number
Provider Enumeration Date
04/27/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4848740 05 MI
P00328166 01 RR-MEDICARE
P00328166 01 MI RR-MEDICARE
institution
Provider Business Practice Location Address Details
Address
20635 Mishawaka Shores Trl
City
Grand Rapids
State
Minnesota
Zip
55744-6071
Phone Number
218-398-0256
Fax Number
person
Provider Business Mailing Address Details
Address
20635 Mishawaka Shores Trl
City
Grand Rapids
State
Minnesota
Zip
55744-6071
Phone Number
218-398-0256
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
4301086765 (Michigan)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
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