Edward J. Lis, Jr, DO, PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

5101014456 Issued in MI

Legal business name

EDWARD J. LIS, JR, DO, PLLC

Practice address

17200 Silver Pkwy
Fenton, MI 48430-4437

Phone

(248) 872-8001

Fax

(248) 872-8001

NPI assigned

Jul 25, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Laurel A Wisniewski, CPC

Title

Credentialing/Coding

Phone

(248) 872-8001

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15740/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward J Lis Jr., D.O.

  • Orthopaedic Surgery Physician
  • Clarkston, MI
  • NPI 1952371338
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500940800000",
    "number": "1578086146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1855",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483471855",
            "telephone_number": "248-872-8001",
            "fax_number": "248-673-8079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17200 SILVER PKWY",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484304437",
            "telephone_number": "248-872-8001",
            "fax_number": "248-872-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD J. LIS, JR, DO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2017-07-25",
        "status": "A",
        "authorized_official_last_name": "WISNIEWSKI",
        "authorized_official_first_name": "LAUREL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING/CODING",
        "authorized_official_telephone_number": "248-872-8001",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101014456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Fenton, MI
• Providers in Fenton, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.