Individual
DR. BLAINE M LISNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3747 DIANN MARIE RD, LOUISVILLE, KY 40241
(502) 426-9200
(502) 426-9259
Mailing address
3707 CHAMBERLAIN LANE, SUITE 101, LOUISVILLE, KY 40241-2091
(502) 426-9200
(502) 426-9259
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
25368
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065238 2
—
IL
01
—
279500
MEDICARE GROUP
—
01
—
P00230839
RAILROAD MEDICARE
—
Enumeration date
08/01/2006
Last updated
08/05/2021
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