Healthcare Provider Details

I. General information

NPI: 1912753039
Provider Name (Legal Business Name): LIELOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E OGDEN AVE STE 114
HINSDALE IL
60521-3658
US

IV. Provider business mailing address

201 E OGDEN AVE STE 114
HINSDALE IL
60521-3658
US

V. Phone/Fax

Practice location:
  • Phone: 630-686-7255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOLMAZ NIKNAM-BIENIA
Title or Position: PRESIDENT
Credential: MD
Phone: 630-686-7255