Provider Demographics
NPI:1982690343
Name:LISOOK, STEVEN M (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:LISOOK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-6922
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:9165 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4847
Practice Address - Country:US
Practice Address - Phone:623-523-6555
Practice Address - Fax:623-523-6586
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ367240Medicaid
AZ367240Medicaid
Z124660Medicare PIN