Provider Demographics
NPI:1477528891
Name:REMER-GILLETTE, LISA A (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:REMER-GILLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:814 PIERCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1058
Mailing Address - Country:US
Mailing Address - Phone:712-226-2600
Mailing Address - Fax:712-226-2605
Practice Address - Street 1:345 W STEAMBOAT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5333
Practice Address - Country:US
Practice Address - Phone:605-217-2175
Practice Address - Fax:605-217-2185
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD5087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7768463Medicaid
IA1208983Medicaid
NE75305796315Medicaid
SDE71814Medicare UPIN
NE75305796315Medicaid
IA1208983Medicaid
SD40580Medicare ID - Type Unspecified