Healthcare Provider Details

I. General information

NPI: 1477645083
Provider Name (Legal Business Name): LISA ELLEN PUTNEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 AMERICA AVE NW
BEMIDJI MN
56601-3122
US

IV. Provider business mailing address

1005 LAKE BLVD NE
BEMIDJI MN
56601-3921
US

V. Phone/Fax

Practice location:
  • Phone: 218-444-8727
  • Fax: 218-444-8546
Mailing address:
  • Phone: 218-751-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number41406
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41406
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: