# ORTHO CLINIC - PROFESSIONAL MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528108503
- **Authorized official:** DR. EDWARD J LISECKI M.D., (PHYSICIAN)
- **Authorized official phone:** (337) 364-5310

## Contact information

- **Practice address:** 516 JEFFERSON TERRRACE BLVD, SUITE 100, NEW IBERIA, LA 70560-4948
- **Practice address phone:** (337) 364-5310
- **Practice address fax:** (337) 364-5313
- **Mailing address:** 516 JEFFERSON TER, SUITE 100, NEW IBERIA, LA 70560-4980
- **Mailing address phone:** (337) 364-5310
- **Mailing address fax:** (337) 364-5313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 26008 | LA | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 01/16/2013