Individual
DR. DANIEL A LIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
927 BROADWAY ST, QUINCY, IL 62301-2719
(217) 214-3447
(217) 214-5819
Mailing address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 214-3447
(217) 214-5819
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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