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NPI Code Detail

MEDICARE: JON H LISCHKE MD

MEDICARE:   JON H LISCHKE  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology PhysicianC31282CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1330627190OTHERCAFEDERAL TAX ID

General Provider Information

NPI Number : 1447298773
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON H LISCHKE MD
Provider Business Mailing Address
First Line : 9339 GENESEE AVE
Second Line : STE 220
City : SAN DIEGO
State : CA
Zip : 92121-2121
Country : US
Telephone Number : 858-455-7520
Fax Number : 858-554-1312
Provider Business Practice Location Address
First Line : 9339 GENESEE AVE STE 220
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-2196
Country : US
Telephone Number : 858-455-7520
Fax Number : 858-554-1312
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 02/06/2023

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Directions to “ JON H LISCHKE MD” Practice Location

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