Provider Demographics
NPI:1497592703
Name:LISK MED SERVICES LLC
Entity type:Organization
Organization Name:LISK MED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISKEILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARPN
Authorized Official - Phone:786-838-3662
Mailing Address - Street 1:2021 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1327
Mailing Address - Country:US
Mailing Address - Phone:786-838-3662
Mailing Address - Fax:
Practice Address - Street 1:2021 SW 129TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-1327
Practice Address - Country:US
Practice Address - Phone:786-838-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty