Individual
CHARLES MARSHALL LIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2850 S WABASH AVE STE 100, CHICAGO, IL 60616-2491
(312) 842-4600
Mailing address
5954 EAGLES WAY, HASLETT, MI 48840-9762
(517) 449-0059
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036136846
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036136846
—
IL
Enumeration date
02/27/2011
Last updated
06/16/2018
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