Liljenquist, Joseph R

Liljenquist, Joseph R is an individual health care provider with primary practice located at 2210 Coronado St , Idaho Falls ID 83404. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Liljenquist, Joseph R can be contacted via phone (208) 522-3355.

Contact Information

Primary practice address
2210 Coronado St Idaho Falls ID 83404
Phone: (208) 522-3355
Fax: (208) 522-6019
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 3587652 Ohio
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X M9781 Idaho

Profile Details

NPI number 1558375568
LBN Legal business name Liljenquist, Joseph R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Sep 1st, 2021 - about 4 years ago

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 1558375568 NPPES
Idaho MEDICAID 807709400

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