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NPI Code Detail

MEDICARE: LISA J GEARS MD

MEDICARE: LISA J GEARS MD
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
1208000000XPediatrics Physician41621MN

General Provider Information

NPI Number : 1396721056
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA J GEARS MD
Provider Business Mailing Address
First Line : 3800 PARK NICOLLET BLVD
Second Line : CREDENTIALING
City : ST LOUIS PARK
State : MN
Zip : 55416-2527
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1415 SAINT FRANCIS AVE
Second Line :
City : SHAKOPEE
State : MN
Zip : 55379-3374
Country : US
Telephone Number : 952-993-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 03/01/2012

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