Individual
MARK S LISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6816 SHADOW CREEK CT, FORT WORTH, TX 76132-4522
(832) 368-6841
Mailing address
PO BOX 16918, FORT WORTH, TX 76162-0918
(323) 686-8418
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0787
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085279001
—
TX
05
—
092841802
—
TX
01
—
82Y991
BCBS
TX
Enumeration date
02/23/2006
Last updated
10/04/2021
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