Basic Information
| Provider Information | |||||||||
| NPI: | 1720028806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | JEANNIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7505 METRO BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554393010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 7505 METRO BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 42569 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 268647300 | 05 | MN | MEDICAID | 300114920 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 2157834 | 05 | IA | MEDICAID | 90D70SC | 01 | MN | BLUE CROSS | OTHER | 150725 | 01 | MN | UCARE | OTHER | 296S9SC | 01 | MN | BLUE CROSS | OTHER | HP31215 | 01 | MN | HEALTHPARTNERS | OTHER | 1024745 | 01 | MN | PREFERRED ONE | OTHER | 796823 | 01 | MN | AMERICA'S PPO | OTHER | 34507500 | 05 | WI | MEDICAID |