Lisa Ann Destefano, D.O

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

5101012158 Issued in MI

Practice address

4660 S Hagadorn Rd Ste 500
East Lansing, MI 48823-6804

Phone

(517) 432-6144

Fax

(517) 432-6150

NPI assigned

Jun 28, 2006

Last updated

Jun 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Lisa Ann Vredevoogd Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michigan State University

  • Family Medicine Physician
  • East Lansing, MI
  • NPI 1861443269
  Medicare reassignment NPD
• Msu Health Care Inc

  • Allergy & Immunology Physician
  • East Lansing, MI
  • NPI 1700418670
  Medicare reassignment NPD
• Michigan State University

  dba Michigan State University Extension

  • Local Education Agency (LEA)
  • East Lansing, MI
  • NPI 1184182982
  NPD
• Michigan State University

  • Pediatrics Physician
  • Okemos, MI
  • NPI 1326121179

  Neuromusculoskeletal Medicine & Omm

  NPD
• Msu Health Care Inc.

  • Physical Therapist
  • East Lansing, MI
  • NPI 1689206419
  NPD
• Msu Health Care Inc.

  • Diagnostic Radiology Physician
  • East Lansing, MI
  • NPI 1275165052
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1336177674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-432-6144",
            "fax_number": "517-432-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S HAGADORN RD STE 500",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488236804",
            "telephone_number": "517-432-6144",
            "fax_number": "517-432-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MI",
            "license": "5101012158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3346153",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "VREDEVOOGD",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jenna Deneka
• Sarah Jean Denham, DO
• Reid Depowski-Knowles, LMSW
• Daniel J. Derksen
• Jacqueline Derose
• Maninder S Deswal, D.P.M.
• Stephanie Joy Deward, M.S.
• Diane Marie Dewey, OWNER/COLLECTOR
• Joseph Edward Dewitt, D.O.
• Erik Daniel Deyoung, D.D.S., M.S.

• Neuromusculoskeletal Medicine & OMM Physician in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.