Individual
DR. JONATHAN MICHAEL LIESKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28554-2538
(910) 450-4159
(910) 450-4194
Mailing address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28554-2538
(910) 450-4803
(910) 450-4194
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0101102522
VA
2083X0100X
Occupational Medicine Physician
0101102522
VA
2085R0202X
Diagnostic Radiology Physician
Primary
62256
VA
Other
Enumeration date
03/08/2006
Last updated
08/08/2023
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