NPIMap

Individual provider Active NPI

Taras Lisowsky, D.O.

  • Family Medicine Physician
  • Warren, MI
National Provider Identifier
1710961990
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101014940 Issued in MI
Practice address
11300 E 13 Mile Rd Ste 1
Warren, MI 48093-2500
Phone
(586) 777-6170
Fax
(586) 777-6582
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101014940 MI Primary

Addresses

Primary practice location

11300 E 13 Mile Rd Ste 1
Warren, MI 48093-2500

Mailing address

11300 E 13 Mile Rd Ste 1
Warren, MI 48093-2500
Phone (586) 777-6170

Other identifiers 2

IdentifierTypeStateIssuer
700H217350OtherMIBLUE SHIELD
1710961990MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040824001349 MI Practitioner - Family Practice 8729052766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Michigan Healthcare Professionals PCGroup PAC ID 0345413258, 525 clinicians

Practice addresses (Care Compare)

27900 Grand River Ave
Suite 220
Farmington Hills, MI 48336-5965
Phone (248) 477-0552

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • McLaren Macomb Hospital, Mount Clemens, MI, CCN 230227
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC CurrentSince Nov 1, 2011 Accepting new patients
Michigan Healthcare Professionals PC Family Medicine CurrentSince Nov 1, 2011 Accepting new patients

Locations

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

25600 Schoenherr Rd
Warren, MI 48089
Phone (586) 777-6170

11300 E 13 Mile Rd
Ste 1
Warren, MI 48093
Phone (586) 777-6170

Interoperability endpoints

  • Direct secure messaging: tlisowsky1139343@direct.hfhs.org
  • Direct secure messaging: tlisowsky@mhcp-mi.direct.office.nextgen.com

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1710961990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11300 E 13 MILE RD STE 1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932500",
            "telephone_number": "586-777-6170",
            "fax_number": "586-777-6582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11300 E 13 MILE RD STE 1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932500",
            "telephone_number": "586-777-6170",
            "fax_number": "586-777-6582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISOWSKY",
        "first_name": "TARAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101014940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "700H217350",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710961990",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.