Provider Demographics
NPI:1184002966
Name:LASKY, LIZL MAUREEN (DO)
Entity Type:Individual
Prefix:
First Name:LIZL
Middle Name:MAUREEN
Last Name:LASKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LIZL
Other - Middle Name:MAUREEN
Other - Last Name:LASKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5100
Mailing Address - Fax:208-625-5101
Practice Address - Street 1:700 W IRONWOOD DR STE 158
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4404
Practice Address - Country:US
Practice Address - Phone:208-625-5100
Practice Address - Fax:208-625-5101
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-13592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology