Healthcare Provider Details

I. General information

NPI: 1548356397
Provider Name (Legal Business Name): RANDY L. LISCH, DPM, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 RESEARCH BLVD SUITE C-13
AUSTIN TX
78758-7012
US

IV. Provider business mailing address

9012 RESEARCH BLVD SUITE C-13
AUSTIN TX
78758-7012
US

V. Phone/Fax

Practice location:
  • Phone: 512-450-0101
  • Fax: 512-450-0086
Mailing address:
  • Phone: 512-450-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDY LAWRENCE LISCH
Title or Position: PRESIDENT
Credential: DPM
Phone: 512-450-0101