Provider Demographics
NPI:1477588622
Name:LISCH, HARVEY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:MICHAEL
Last Name:LISCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE #226
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9015
Mailing Address - Country:US
Mailing Address - Phone:512-259-3338
Mailing Address - Fax:512-528-1472
Practice Address - Street 1:601 E WHITESTONE BLVD
Practice Address - Street 2:SUITE #226
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9015
Practice Address - Country:US
Practice Address - Phone:512-259-3338
Practice Address - Fax:512-528-1472
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17809001Medicaid
TXU65729Medicare UPIN
TX82301JMedicare PIN