Provider Demographics
NPI:1972552370
Name:LIZAK, RICHARD J (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:LIZAK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:281 N 12TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1101
Practice Address - Country:US
Practice Address - Phone:610-377-7793
Practice Address - Fax:484-403-4015
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-08-12
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Provider Licenses
StateLicense IDTaxonomies
PAOS008213L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110189148OtherPALMETTO RR
PA553701OtherHIGHMARK PA BLUE SHIELD
PA01054302OtherCAPITAL BLUE CROSS
PAG39181Medicare UPIN
PA553701KZJMedicare PIN
PA110189148OtherPALMETTO RR