Liesen, Kenneth J

Liesen, Kenneth J is an sole proprietor health care provider with primary practice located at 606 Riverside Ave , St Charles IL 60174-2969. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Liesen, Kenneth J can be contacted via phone (630) 584-8900.

Contact Information

Primary practice address
606 Riverside Ave St Charles IL 60174-2969
Phone: (630) 584-8900
Fax: (630) 584-2806
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-077277 Illinois

Profile Details

NPI number 1699896498
LBN Legal business name Liesen, Kenneth J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 2nd, 2007
Last updated Jun 10th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699896498 NPPES
Illinois MEDICAID 036077277
Illinois Other 966700
Illinois Other 036077277
Illinois Other 036077277

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