Healthcare Provider Details

I. General information

NPI: 1912929159
Provider Name (Legal Business Name): THOMAS E. LIESER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 NAVARRE AVE
OREGON OH
43616-3308
US

IV. Provider business mailing address

3028 NAVARRE AVE
OREGON OH
43616-3308
US

V. Phone/Fax

Practice location:
  • Phone: 419-697-6850
  • Fax: 419-697-6861
Mailing address:
  • Phone: 419-697-6850
  • Fax: 419-697-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35-057135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: