MEDICARE: MRS. SOFIA ANA LIESER 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	207V00000X	Obstetrics & Gynecology Physician	35120978	OH
2	207V00000X	Obstetrics & Gynecology Physician	Q4178	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1033353099	OTHER	OH	BWC

General Provider Information

NPI Number	:	1033353099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOFIA ANA LIESER M.D.

Provider Business Mailing Address
First Line	:	1600 W COLLEGE ST STE 540
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-3589
Country	:	US
Telephone Number	:	817-481-5863
Fax Number	:	817-329-8561

Provider Business Practice Location Address
First Line	:	1600 W COLLEGE ST STE 540
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-3589
Country	:	US
Telephone Number	:	817-481-5863
Fax Number	:	817-329-8561

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	06/02/2023

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