Provider Demographics
NPI:1548222482
Name:WASSERMAN, LISA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RUTH
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 LOUISIANA AVE S
Mailing Address - Street 2:SUITE 400E
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-5000
Mailing Address - Country:US
Mailing Address - Phone:952-993-3232
Mailing Address - Fax:
Practice Address - Street 1:3931 LOUISIANA AVE S
Practice Address - Street 2:SUITE 400E
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-5000
Practice Address - Country:US
Practice Address - Phone:952-993-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47293207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2371982OtherAMERICA'S PPO
MN382154400Medicaid
MN1042879OtherPREFERRED ONE ID
MN182P7WAOtherBLUECROSS BLUE SHIELD
MNHP48036OtherHEALTH PARTNERS
MN0902076OtherMEDICA PROV #
MN0902076OtherSELECT CARE
MN1042879OtherPREFERRED ONE ID
200002900Medicare PIN