Provider Demographics
NPI:1831383991
Name:ROEDER, LISA RENEE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:ROEDER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:NOTRE DAME WELLNESS CENTER
Mailing Address - Street 2:100 WELLNESS CENTER
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556
Mailing Address - Country:US
Mailing Address - Phone:574-634-9355
Mailing Address - Fax:574-631-3377
Practice Address - Street 1:100 WELLNESS CENTER
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556
Practice Address - Country:US
Practice Address - Phone:574-634-9355
Practice Address - Fax:574-631-3377
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2024-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01061268A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine