Provider Demographics
NPI:1568544070
Name:SCHIMMENTI, LISA ANN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SCHIMMENTI
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 1:200 1ST SWST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST SWST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35223207SG0201X, 207Y00000X, 208000000X
FLME142762207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10387Medicaid
MN1031492OtherPREFERRED ONE
MT0389529Medicaid
SD7777470Medicaid
MNHP40419OtherHEALTH PARTNERS
MN12-01849OtherMEDICA CHOICE
MN313090800Medicaid
IA0549923Medicaid
MN12-09026OtherMEDICA PRIMARY
MN142097OtherUCARE
MN1671087OtherARAZ
MN142097OtherUCARE