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General NPI Number Information
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NPI Number | 1366528457
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Entity Type | Individual
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Provider Name | RONALD MARTIN LISAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 5071 HIDDEN CREEK CIR
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City | SOLON
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State | OH
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Zip | 44139-1190
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Country | US
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Telephone | 440-542-0550
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.060203
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | MD036837E
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License Number State | PA
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