Individual
JENNIFER LIEDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 834-4064
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4127
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
036102039
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102039
—
IL
Enumeration date
01/11/2007
Last updated
01/31/2019
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