MEDICARE: MRS. LISA MARIE FRITZ P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	8947	MN

General Provider Information

NPI Number	:	1578581682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE FRITZ P.A.

Provider Business Mailing Address
First Line	:	1950 CURVE CREST BLVD W
Second Line	:	SUITE 100
City	:	STILLWATER
State	:	MN
Zip	:	55082-5078
Country	:	US
Telephone Number	:	651-430-3800
Fax Number	:	651-430-1447

Provider Business Practice Location Address
First Line	:	1950 CURVE CREST BLVD W
Second Line	:	SUITE 100
City	:	STILLWATER
State	:	MN
Zip	:	55082-5078
Country	:	US
Telephone Number	:	651-430-3800
Fax Number	:	651-430-1447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/10/2008

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