Active NPI
Mara Lauren Liss, M.D.
- Pediatrics Physician
- Minnetonka, MN
National Provider Identifier
1972795920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 53077
- Practice address
- 14001 Ridgedale Dr
Suite 100
Minnetonka, MN 55305-1753 - Phone
- (952) 473-0211
- NPI assigned
- Aug 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 53077 | MN | Primary |
Addresses
Primary practice location
14001 Ridgedale Dr
Suite 100
Minnetonka, MN 55305-1753
Mailing address
4370 Browndale Ave
St Louis Park, MN 55424-1012
Phone (763) 234-6632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53077 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490832000000",
"number": "1972795920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4370 BROWNDALE AVE",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554241012",
"telephone_number": "763-234-6632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14001 RIDGEDALE DR",
"address_2": "SUITE 100",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051753",
"telephone_number": "952-473-0211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISS",
"first_name": "MARA",
"middle_name": "LAUREN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-14",
"last_updated": "2017-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "53077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.