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Individual
DR. MATTHEW ERIC LISSAUER
Active
Individual
DR. MATTHEW ERIC LISSAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
69621
CT
2086S0102X
Surgical Critical Care Physician
D63229
MD
2086S0127X
Trauma Surgery Physician
Primary
69621
CT
2086S0127X
Trauma Surgery Physician
D0063229
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408282600
—
MD
01
—
P00259987
RAILROAD MEDICARE
MD
Enumeration date
04/06/2006
Last updated
10/13/2021
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