Provider Demographics
NPI:1336206077
Name:LISECKI, EDWARD J (MD,)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:LISECKI
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Gender:M
Credentials:MD,
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Mailing Address - Street 1:516 JEFFERSON TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4948
Mailing Address - Country:US
Mailing Address - Phone:337-364-5310
Mailing Address - Fax:337-364-5313
Practice Address - Street 1:516 JEFFERSON TER
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4948
Practice Address - Country:US
Practice Address - Phone:337-364-5310
Practice Address - Fax:337-364-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-05-29
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Provider Licenses
StateLicense IDTaxonomies
LA26008207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery