Individual
JOHN C LYSKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2701 W EDGEWOOD DR, SUITE 101, JEFFERSON CITY, MO 65109-5889
(573) 634-5303
(573) 761-6888
Mailing address
PO BOX 1027, JEFFERSON CITY, MO 65102-1027
(573) 681-3767
(573) 761-6947
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
R1B98
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201418233
—
MO
Enumeration date
08/11/2006
Last updated
06/24/2015
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