MEDICARE: DR. WILLIAM EDWARD LIEVENS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	29280	AL
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	29280	AL
3	2084N0600X	Clinical Neurophysiology Physician	29280	AL
4	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	29280	AL
5	261QM2800X	Methadone Clinic	29280	AL
6	273100000X	Epilepsy Hospital Unit	29280	AL
7	2084N0400X	Neurology Physician	29280	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29280	OTHER	AL	ALABAMA STATE BOARD OF MEDICAL EXAMINERS, CONTROLLED SUBSTANCES REGISTRATION
2	3634532	OTHER	AL	UNITED HEALTH CARE
3	57026	OTHER		BOARD CERTIFIED IN NEUROLOGY, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY
4	MD.29280	OTHER	AL	ALABAMA MEDICAL LICENSURE COMMISSION
5	511-36880	OTHER	AL	BLUE ADVANTAGE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4448615	OTHER	AL	CIGNA
8	511-36880	OTHER	AL	BLUE CROSS/BLUE SHIELD OF ALABAMA
9	12562126	OTHER	AL	CAQH
10	XXXXX9748	OTHER	AL	TRICARE / HUMANA MILITARY

General Provider Information

NPI Number	:	1013110006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EDWARD LIEVENS M.D.

Provider Business Mailing Address
First Line	:	2400 MIDFIELD DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-1529
Country	:	US
Telephone Number	:	334-239-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 E SHIRLEY LN
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1935
Country	:	US
Telephone Number	:	334-244-1618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/07/2023

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