Provider Demographics
NPI:1932858594
Name:LISEK, MAREK J (DO)
Entity type:Individual
Prefix:DR
First Name:MAREK
Middle Name:J
Last Name:LISEK
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BELOIT HEALTH SYSTEM INC
Mailing Address - Street 2:1969 W HART ROAD
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2230
Mailing Address - Country:US
Mailing Address - Phone:608-364-5011
Mailing Address - Fax:608-364-5525
Practice Address - Street 1:BELOIT HEALTH SYSTEM
Practice Address - Street 2:1969 W HART ROAD
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2230
Practice Address - Country:US
Practice Address - Phone:608-363-5971
Practice Address - Fax:608-363-5737
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81395-21207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100281912Medicaid