| Dr Lea Quitania Lisowski, MD | |
|
10003 Us Route 30, Waterman, IL 60556 | |
| (815) 264-3484 | |
| (815) 264-8659 |
| Full Name | Dr Lea Quitania Lisowski |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 10003 Us Route 30, Waterman, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669687315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36116636 (Illinois) | Primary |
| Entity Name | Northwestern Medical Faculty Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1346235314 PECOS PAC ID: 4587576814 Enrollment ID: O20031105000541 |
| Entity Name | Edward Health Ventures |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962452912 PECOS PAC ID: 4284531484 Enrollment ID: O20031216000616 |
| Entity Name | Central Dupage Physician Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033149844 PECOS PAC ID: 5890696231 Enrollment ID: O20040303000601 |
| Entity Name | Oak Street Health Physicians Group PC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083051643 PECOS PAC ID: 7517109879 Enrollment ID: O20130815000670 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Lea Quitania Lisowski, MD 10003 Us Route 30, Waterman, IL 60556-7128 Ph: (815) 264-3484 | Dr Lea Quitania Lisowski, MD 10003 Us Route 30, Waterman, IL 60556 Ph: (815) 264-3484 |