Healthcare Provider Details

I. General information

NPI: 1073568796
Provider Name (Legal Business Name): MICHAEL J LISTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 100A
ORLAND PARK IL
60462-4600
US

IV. Provider business mailing address

12251 S 80TH AVE STE 1630
PALOS HEIGHTS IL
60463-1256
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4400
  • Fax: 708-590-6605
Mailing address:
  • Phone: 708-923-5173
  • Fax: 708-923-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036.064198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: