Individual
DR. DANIEL A LIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036115999
IL
2086S0127X
Trauma Surgery Physician
Primary
036115999
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036115999
LICENSE
IL
05
—
036115999
—
IL
Enumeration date
09/07/2006
Last updated
02/02/2024
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