MEDICARE: DR. STEVEN M LISOOK DO

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
1	207Q00000X	Family Medicine Physician	4567	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982690343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M LISOOK DO

Provider Business Mailing Address
First Line	:	13640 N PLAZA DEL RIO BLVD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4846
Country	:	US
Telephone Number	:	623-876-6922
Fax Number	:	623-972-9590

Provider Business Practice Location Address
First Line	:	9165 W THUNDERBIRD RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4847
Country	:	US
Telephone Number	:	623-523-6555
Fax Number	:	623-523-6586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	03/02/2009

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