Healthcare Provider Details

I. General information

NPI: 1699339770
Provider Name (Legal Business Name): ADAM LYSIAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GEORGIAN DRIVE DEPARTMENT OF ANESTHESIOLOGY
BARRIE ONTARIO
L4M6Z7
CA

IV. Provider business mailing address

201 GEORGIAN DRIVE
BARRIE ONTARIO
L4M6Z7
CA

V. Phone/Fax

Practice location:
  • Phone: 705-985-6728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125075007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: