Provider Demographics
NPI:1558349662
Name:KEISKI, LISA K (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:KEISKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 HIGH ST
Mailing Address - Street 2:STE. 4
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2496
Mailing Address - Country:US
Mailing Address - Phone:207-443-4471
Mailing Address - Fax:207-442-0407
Practice Address - Street 1:765 HIGH ST
Practice Address - Street 2:STE. 4
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2496
Practice Address - Country:US
Practice Address - Phone:207-443-4471
Practice Address - Fax:207-442-0407
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432011499Medicaid
ME432011499Medicaid
ME1668Medicare PIN
MEE400271185Medicare UPIN
ME1668Medicare PIN