Individual
DR. ZACHARY JONATHAN LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
Mailing address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
4301092867
MI
2088P0231X
Pediatric Urology Physician
Primary
4301092867
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340E062730
BCBSM
MI
01
—
CB9133
RAILROAD MEDICARE
MI
Enumeration date
03/12/2009
Last updated
08/06/2015
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