Most Relevant Information
Provider Data
| NPI Number: | 1003810789 |
| Provider Name: | LISA G. DISTEFANO M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 207R00000X |
| Specialty: | Internal Medicine |
| License Number: | 119536 |
Most Important Dates
| Enumeration Date: | 06/09/2005 |
| Last Updated: | 11/09/2012 |
Provider Practice Location
2016 S MAIN ST
MARYVILLE
MO
644682655
Practice Location Phone/Fax
| Phone: | 6605622525 |
| Fax: | 6605627993 |
Provider Mailing Location
114 E SOUTH HILLS DR
MARYVILLE
MO
644682659
Provider Mailing Phone/Fax
| Phone: | 6605622525 |
| Fax: | 6605624303 |
Suggested EMR
Internist EMR