Healthcare Provider Details

I. General information

NPI: 1548351687
Provider Name (Legal Business Name): ROBERT M LIESMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E 7TH ST SUITE 102
CHARLOTTE NC
28204-3307
US

IV. Provider business mailing address

2115 E 7TH ST SUITE 102
CHARLOTTE NC
28204-3307
US

V. Phone/Fax

Practice location:
  • Phone: 704-442-8433
  • Fax: 704-817-9957
Mailing address:
  • Phone: 704-442-8433
  • Fax: 704-817-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number356
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: