Provider Demographics
NPI:1558833244
Name:MICHELLE LISKE MD INC
Entity Type:Organization
Organization Name:MICHELLE LISKE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-356-5600
Mailing Address - Street 1:4340 GENESEE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4940
Mailing Address - Country:US
Mailing Address - Phone:858-356-5600
Mailing Address - Fax:858-356-4965
Practice Address - Street 1:4340 GENESEE AVE STE 207
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4940
Practice Address - Country:US
Practice Address - Phone:858-356-5600
Practice Address - Fax:858-356-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty