Provider Demographics
NPI:1235362971
Name:LISTON, MICHAEL JAMES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:LISTON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-705-5605
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:100 GORE RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-9466
Practice Address - Country:US
Practice Address - Phone:815-364-8919
Practice Address - Fax:815-942-4913
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2018-10-23
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Provider Licenses
StateLicense IDTaxonomies
IL036.129326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine