Individual
KELLY LIESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3522 10TH ST NW, WASHINGTON, DC 20010-1480
(630) 660-0161
Mailing address
3522 10TH ST NW, WASHINGTON, DC 20010-1480
(630) 660-0161
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036.152067
IL
208000000X
Pediatrics Physician
A172837
CA
208000000X
Pediatrics Physician
Primary
MD210011400
DC
Other
Enumeration date
03/18/2017
Last updated
08/13/2023
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