Provider Demographics
NPI:1669687315
Name:LISOWSKI, LEA QUITANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:QUITANIA
Last Name:LISOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEA
Other - Middle Name:PAGKALIWANGAN
Other - Last Name:QUITANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10003 US ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:WATERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:60556-7128
Mailing Address - Country:US
Mailing Address - Phone:815-264-3484
Mailing Address - Fax:815-264-8659
Practice Address - Street 1:10003 US ROUTE 30
Practice Address - Street 2:
Practice Address - City:WATERMAN
Practice Address - State:IL
Practice Address - Zip Code:60556
Practice Address - Country:US
Practice Address - Phone:815-264-3484
Practice Address - Fax:815-264-8659
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36116636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine