Individual
JOHN C. LYSTASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
29 PLANTATION PARK DR, BLUFFTON, SC 29910-9001
(843) 706-7090
Mailing address
12 PRIMROSE LN, HILTON HEAD ISLAND, SC 29926-2244
(540) 309-8210
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101038597
VA
207RC0000X
Cardiovascular Disease Physician
Primary
91175
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336132729
—
VA
Enumeration date
08/31/2005
Last updated
06/14/2024
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