Individual
ERIC LISIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
128 N WHITNEY AVE, COOKEVILLE, TN 38501-2493
(931) 783-5848
(931) 528-1266
Mailing address
140 W 7TH ST, COOKEVILLE, TN 38501-1726
(931) 783-5582
(931) 526-6760
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2669
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6018834
BCBS
TN
05
—
7100423360
—
KY
05
—
Q007183
—
TN
Enumeration date
04/27/2011
Last updated
05/26/2022
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