Provider Demographics
NPI:1851362214
Name:BATCHELOR, LISA YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:YVONNE
Last Name:BATCHELOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:YVONNE
Other - Last Name:ROLSTAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3925 OTTAWA AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3017
Mailing Address - Country:US
Mailing Address - Phone:952-926-7900
Mailing Address - Fax:952-380-5371
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 250
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22G36ROOtherBLUE CROSS
MNCP9041016908OtherPREFERRED ONE
MN1212926OtherMEDICA
MN122923OtherUCARE
MNCP9041016908OtherPREFERRED ONE