Provider Demographics
NPI:1720028806
Name:SCHNEIDER, LISA JEANNIE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEANNIE
Last Name:SCHNEIDER
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 1:7505 METRO BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3010
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7505 METRO BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN425692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN268647300Medicaid
MN300114920OtherRAILROAD MEDICARE MN
IA2157834Medicaid
MN90D70SCOtherBLUE CROSS
MN150725OtherUCARE
MN296S9SCOtherBLUE CROSS
MNHP31215OtherHEALTHPARTNERS
MN1024745OtherPREFERRED ONE
MN796823OtherAMERICA'S PPO
WI34507500Medicaid
MN300002234Medicare PIN
MNG54888Medicare UPIN
WI34507500Medicaid
MN300002252Medicare PIN