Individual
MR. KEITH E LIPTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1304 FRANKLIN AVE, NORMAL, IL 61761-3558
(309) 454-1400
Mailing address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 846-4716
(309) 948-6100
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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