Active NPI
Daniel Theodore Lis Jr., M.D.
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1043471600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036123897
- Practice address
- 836 W Wellington Ave
Chicago, IL 60657-5147 - Phone
- (773) 975-1600
- NPI assigned
- Jun 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036123897 | IL | Primary |
Addresses
Primary practice location
836 W Wellington Ave
Chicago, IL 60657-5147
Mailing address
655 W Irving Park Rd
Apt 907
Chicago, IL 60613-3123
Phone (248) 890-4955
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036123897 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Memorial Hospital Corporatio | Past | Accepting new patients | |
| Ped PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EAGJBD/Endpoint/EAGJBD
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Monroe, MI
- NPI 1811097223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261353600000",
"number": "1043471600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 W IRVING PARK RD",
"address_2": "APT 907",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606133123",
"telephone_number": "248-890-4955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "836 W WELLINGTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606575147",
"telephone_number": "773-975-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIS",
"first_name": "DANIEL",
"middle_name": "THEODORE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-17",
"last_updated": "2009-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036123897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.