Individual
DR. DAVID MICHAEL LISCOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
930 BLUE STAR HWY, SOUTH HAVEN, MI 49090-7758
(269) 637-1115
(269) 639-1314
Mailing address
930 BLUE STAR HWY, SOUTH HAVEN, MI 49090-7758
(269) 637-1115
(269) 639-1314
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301048560
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131169
PHP/IBA
MI
01
—
080027374
RR MEDICARE
MI
01
—
080H06004
BCBSM
MI
05
—
1656193
—
MI
01
—
5468088
AETNA
MI
01
—
P53524
BCN
MI
Enumeration date
08/31/2006
Last updated
12/01/2020
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