Individual
KEVIN LISKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(779) 696-4400
Mailing address
1175 SHINGLE OAK LN, ROCKFORD, IL 61107-2836
(815) 540-2832
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.008159
IL
Other
Enumeration date
04/11/2020
Last updated
12/22/2022
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