Individual
DR. PHILIP CHARLES LIETHEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2616 WHITNEY PL, FORT GRATIOT, MI 48059-3952
(586) 246-5746
Mailing address
2616 WHITNEY PL, FORT GRATIOT, MI 48059-3952
(586) 246-5746
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2082
WI
103G00000X
Clinical Neuropsychologist
Primary
3063
MI
Other
Enumeration date
12/14/2005
Last updated
07/08/2007
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