MEDICARE: ANTON LISHMANOV M.D., PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2012-01544	NC
2	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	E-13739	AR
3	207RC0000X	Cardiovascular Disease Physician	2012-01544	NC
4	207RC0000X	Cardiovascular Disease Physician	E-13739	AR
5	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	201201544	NC
6	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	E-13739	AR
7	207RI0011X	Interventional Cardiology Physician	E-13739	AR
8	207RI0011X	Interventional Cardiology Physician	201201544	NC
9	207RI0011X	Interventional Cardiology Physician	ME132480	FL
10	207UN0901X	Nuclear Cardiology Physician	201201544	NC
11	207UN0901X	Nuclear Cardiology Physician	E-13739	AR
12	207RC0000X	Cardiovascular Disease Physician	ME132480	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275763757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTON LISHMANOV M.D., PHD

Provider Business Mailing Address
First Line	:	14100 FIVAY RD STE 160
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7194
Country	:	US
Telephone Number	:	277-862-1080
Fax Number	:	727-863-3093

Provider Business Practice Location Address
First Line	:	14100 FIVAY RD STE 160
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7194
Country	:	US
Telephone Number	:	727-862-1080
Fax Number	:	727-863-3093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	08/14/2025

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