Individual
DR. BRADLEY ALEX LISKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 POLARIS PKWY, STE 250, WESTERVILLE, OH 43082-8074
(614) 865-4800
(614) 865-4900
Mailing address
110 POLARIS PKWY, STE 250, WESTERVILLE, OH 43082-8074
(614) 865-4900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
350633629L
OH
208000000X
Pediatrics Physician
35063629L
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154069
—
OH
Enumeration date
05/31/2005
Last updated
04/29/2021
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