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General NPI Number Information
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NPI Number | 1336206077
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Entity Type | Individual
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Provider Name | EDWARD J LISECKI M.D.,
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 516 JEFFERSON TER SUITE 100
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City | NEW IBERIA
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State | LA
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Zip | 70560-4948
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Country | US
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Telephone | 337-364-5310
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Fax | 337-364-5313
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Provider Business Mailing Address
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Address Line | 516 JEFFERSON TER SUITE 100
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City | NEW IBERIA
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State | LA
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Zip | 70560-4948
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Country | US
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Telephone | 337-364-5310
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Fax | 337-364-5313
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 26008
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License Number State | LA
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