Individual
DR. JOAN WANDA LISAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
780 CHESTNUT ST, SUITE 20, SPRINGFIELD, MA 01107-1610
(413) 781-2200
(413) 781-2202
Mailing address
PO BOX 2041, SPRINGFIELD, MA 01101-2041
(413) 781-2200
(413) 781-2202
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
57480
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3089428
—
MA
Enumeration date
07/12/2006
Last updated
12/15/2017
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