Provider Demographics
NPI:1093843062
Name:MEDVENTURES MEDICAL LLC
Entity type:Organization
Organization Name:MEDVENTURES MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LISKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FC CP
Authorized Official - Phone:815-786-3060
Mailing Address - Street 1:831 SANDHURST DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1186
Mailing Address - Country:US
Mailing Address - Phone:815-786-3060
Mailing Address - Fax:815-786-8701
Practice Address - Street 1:225 EDWARD ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2137
Practice Address - Country:US
Practice Address - Phone:815-786-3060
Practice Address - Fax:815-786-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1912056284OtherFOXLAND RESPIRATORY NPI #
IL1790752988OtherDR. THOMAS LISKE NPI #
IL1932096OtherBC/BS
IL1Medicaid
ILD10180Medicare UPIN
IL1790752988OtherDR. THOMAS LISKE NPI #