Healthcare Provider Details

I. General information

NPI: 1366900144
Provider Name (Legal Business Name): LIEZL ZEEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51ST MEDICAL GROUP, UNIT 2060
APO AP
96278-2060
US

IV. Provider business mailing address

UNIT 6180 BOX 31ST
APO AE
09604-6180
US

V. Phone/Fax

Practice location:
  • Phone: 505-784-2512
  • Fax:
Mailing address:
  • Phone: 314-632-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270938
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101270938
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: