Individual
EDWARD J LIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6310 SASHABAW RD, SUITE A, CLARKSTON, MI 48346-2270
(248) 620-2325
(248) 620-2326
Mailing address
6310 SASHABAW RD, SUITE A, CLARKSTON, MI 48346-2270
(248) 620-2325
(248) 620-2326
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
5101014456
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4623098
—
MI
Enumeration date
01/26/2006
Last updated
07/08/2007
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