Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Lisa Deette Staber, MD

Individual provider Family Medicine Physician · NPI 1629035308

Dr. Lisa Deette Staber, MD is a Family Practice in Grand Rapids, Minnesota. Graduated from Sanford School of Medicine of University of South Dakota in 1987, 39 years ago. Practices with Avera Tyler, a 15-clinician group. Licensed in Michigan, Minnesota and Wisconsin.

Years since qualifying
39
Trained at
Sanford School of Medicine of University of South Dakota
Licensed in
MI, MN, WI
In the registry since
2006
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

20635 Mishawaka Shores Trl
Grand Rapids, MN 55744-6071
Phone: (218) 398-0256
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 38922 (MN)
Family Medicine Physician Taxonomy 207Q00000X · Licence 4301086765 (MI)
Family Medicine Physician Taxonomy 207Q00000X · Licence 38751-020 (WI)
Family Medicine Physician Taxonomy 207Q00000X · Licence 38751-20 (WI)

Record details

NPI number1629035308
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 27, 2006
Last updated in NPPESMay 9, 2017

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolSANFORD SCHOOL OF MEDICINE OF UNIVERSITY OF SOUTH DAKOTA
Graduated 1987 (39 years in practice)
Group practice Avera Tyler — 15 clinicians
Accepts Medicare assignment Not indicated
Practice locations4 on file with Medicare

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