Provider Demographics
NPI:1770593055
Name:FARNBERG, LISA M (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:FARNBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:GILLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 1ST DR NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2941
Mailing Address - Country:US
Mailing Address - Phone:507-433-7351
Mailing Address - Fax:
Practice Address - Street 1:1000 1ST DR NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-433-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35197207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN036695100Medicaid
MN11S28FAOtherBCBS NUMBER
MN127795OtherU-CARE NUMBER
MN20-00257OtherMEDICA NUMBER
MNHP59269OtherHEALTHPARTNERS NUMBER
MN1023007OtherPREFERRED ONE NUMBER
NE41091744413Medicaid
MN036695100Medicaid
MN127795OtherU-CARE NUMBER
MNHP59269OtherHEALTHPARTNERS NUMBER