Healthcare Provider Details

I. General information

NPI: 1538783147
Provider Name (Legal Business Name): MICHAEL D SISLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL D EMERSON DO

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LYSTER ARMY HEALTH CLINIC (LAHC) 301 ANDREWS AVE. BUILD 301
FORT RUCKER AL
36362
US

IV. Provider business mailing address

LAHC 301 ANDREWS AVE.
FORT RUCKER AL
36362
US

V. Phone/Fax

Practice location:
  • Phone: 800-261-7193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102207184
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0102207184
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: