Healthcare Provider Details

I. General information

NPI: 1932858594
Provider Name (Legal Business Name): MAREK J LISEK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/13/2025
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELOIT HEALTH SYSTEM 1969 W HART ROAD
BELOIT WI
53511-2230
US

IV. Provider business mailing address

BELOIT HEALTH SYSTEM INC 1969 W HART ROAD
BELOIT WI
53511-2230
US

V. Phone/Fax

Practice location:
  • Phone: 608-363-5971
  • Fax: 608-363-5737
Mailing address:
  • Phone: 608-364-5011
  • Fax: 608-364-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81395-21
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number81395-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: