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General NPI Number Information
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NPI Number | 1831383991
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Entity Type | Individual
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Provider Name | LISA RENEE ROEDER MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 100 WELLNESS CENTER
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City | NOTRE DAME
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State | IN
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Zip | 46556
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Country | US
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Telephone | 574-634-9355
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Fax | 574-631-3377
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Provider Business Mailing Address
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Address Line | NOTRE DAME WELLNESS CENTER 100 WELLNESS CENTER
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City | NOTRE DAME
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State | IN
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Zip | 46556
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Country | US
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Telephone | 574-634-9355
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Fax | 574-631-3377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01061268A
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License Number State | IN
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