Provider Demographics
NPI:1467451971
Name:LISMAN, KEVIN ARLIE (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ARLIE
Last Name:LISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 FANNIN ST STE 801
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5870
Mailing Address - Country:US
Mailing Address - Phone:713-790-0841
Mailing Address - Fax:713-790-9663
Practice Address - Street 1:5115 FANNIN ST STE 801
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5870
Practice Address - Country:US
Practice Address - Phone:713-790-0841
Practice Address - Fax:713-790-9663
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5335207RI0011X, 207RC0000X
TX2928207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105053603Medicaid
TXP00021292OtherRR MEDICARE
TX8A6271OtherBCBS
TX105053603Medicaid
TX105053604Medicaid
TX105053604Medicaid
TX105053603Medicaid
TX8A7913Medicare PIN
TXP00021292OtherRR MEDICARE