DR. JACK S LISSAUER MD NPI 1720087356

NPI Information

NPI: 1720087356
Provider Name: DR. JACK S LISSAUER, MD
Classification: Internal Medicine - 207RG0100X
Entity Type: Individual

Specialization: Gastroenterology

Address:
3700 PARK EAST DR
SUITE 100
BEACHWOOD, OH
ZIP 44122
Phone: (216) 593-7700
Get Directions

DR. Jack S Lissauer, MD is a gastroenterology internal medicine in Beachwood, OH. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. DR. Jack S Lissauer, MD NPI is 1720087356. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3700 PARK EAST DR
SUITE 100
BEACHWOOD, OH
ZIP 44122-339
Phone: (216) 593-7700
Fax: (216) 593-7190

The enumeration date for this NPI number is 7/15/2005 and was last updated on 10/24/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RG0100X	Internal Medicine	Gastroenterology	35038212L	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5089882001	OTHER	OHIO	CIGNA
2	000000127021	OTHER	OHIO	OHIO OPERATING ENGINEERS
3	4079026	OTHER	OHIO	AETNA
4	0307699	MEDICAID	OHIO
5	LI0421211	MEDICARE PIN	OHIO
6	000000127021	OTHER	OHIO	ANTHEM BCBS & ANTHEM SR
7	P1482889	OTHER	OHIO	OXFORD INSURANCE
8	603650	OTHER	OHIO	UNITED HEALTHCARE
9	LI0421211	MEDICARE ID-TYPE UNSPECIFIED	OHIO	MEDICARE
10	000000127021	OTHER	OHIO	ONE NATION BENEFIT ADMIN.
11	R38212	OTHER	OHIO	APEX & SUMMACARE
12	LI0421212	MEDICARE ID-TYPE UNSPECIFIED	OHIO	MEDICARE
13	A75550	MEDICARE UPIN	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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