Basic Information
| Provider Information | |||||||||
| NPI: | 1710924188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LISCHNER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 ETHAN WAY STE 600 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958252296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793590 | ||||||||
| FaxNumber: | 9164823647 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MEDICAL PLAZA DR | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956612865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793590 | ||||||||
| FaxNumber: | 9164823647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | G16319 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 00G163190 | 05 | CA | MEDICAID |