Individual
MR. LESLIE P LIEGEL
Active
Individual
MR. LESLIE P LIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
819-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009390
PHYS PLUS PROV #
WI
05
—
42950700
—
WI
01
—
70
DEANCARE PROV #
WI
01
—
P00144568
RAILROAD MEDICARE PROV #
WI
Enumeration date
12/15/2005
Last updated
06/23/2020
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