Mark D Lisby, MD
Family Medicine in Indianapolis, IN. Individual provider (NPI-1).
NPI number1861574485
StatusActive
Last updated in NPPESJun 9, 2021
Details
- NPI
- 1861574485
- Entity type
- Individual (NPI-1)
- Name
- Mark D Lisby
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 20, 2006
- Certification date
- Jun 9, 2021
- Last updated
- Jun 9, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 01038785A | IN | Yes |
Practice location
10122 E 10th StSuite 100
Indianapolis, IN 46229-2663
Phone 317-355-5717 · Fax 317-355-3760
Mailing address
6626 E 75th StSuite 500
Indianapolis, IN 46250-2805
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