Individual
DR. BRIAN ALLEN LISHAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 922-9270
(231) 922-9271
Mailing address
PO BOX 107, TRAVERSE CITY, MI 49685-0107
(231) 922-9270
(231) 922-9271
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301093912
MI
207R00000X
Internal Medicine Physician
Primary
L 246-127
NY
208000000X
Pediatrics Physician
4301093912
MI
208000000X
Pediatrics Physician
L 246-127
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/15/2006
Last updated
06/15/2009
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