Provider Demographics
NPI:1588699730
Name:LISCH, RANDY LAWRENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LAWRENCE
Last Name:LISCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 RESEARCH BLVD
Mailing Address - Street 2:SUITE C-13
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7012
Mailing Address - Country:US
Mailing Address - Phone:512-450-0101
Mailing Address - Fax:512-450-0086
Practice Address - Street 1:9012 RESEARCH BLVD
Practice Address - Street 2:SUITE C-13
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7012
Practice Address - Country:US
Practice Address - Phone:512-450-0101
Practice Address - Fax:512-450-0086
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079893601Medicaid
TXT14431Medicare UPIN
TX82300JMedicare PIN