| Kenneth J Liesen Md Sc | |
|
606 Riverside Ave St Charles IL 60174-2969 | |
| (630) 584-8900 | |
| (630) 584-2806 |
| Full Name | Kenneth J Liesen Md Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 606 Riverside Ave, St Charles, Illinois |
| Authorized Official Name and Position | Kenneth J Liesen (MEDICAL DOCTOR) |
| Authorized Official Contact | 6305848900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth J Liesen Md Sc 606 Riverside Ave St Charles IL 60174-2969 Ph: (630) 584-8900 | Kenneth J Liesen Md Sc 606 Riverside Ave St Charles IL 60174-2969 Ph: (630) 584-8900 |
| NPI Number | 1124223763 |
|---|---|
| Provider Enumeration Date | 06/15/2007 |
| Last Update Date | 01/17/2014 |
| Medicare PECOS PAC ID | 7618157850 |
|---|---|
| Medicare Enrollment ID | O20110205000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124223763 | NPI | - | NPPES |
| 036077277 | Medicaid | IL | |
| 966700 | Other | IL | INDIVIDUAL MEDICARE PTAN |
| 036077277 | Other | IL | BCBS |
| 943790 | Other | IL | GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036077277 (Illinois) | Primary |
Bodyworks Medical Center Of Stc Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 923 S Randall Rd, St Charles, IL 60174 Phone: 630-517-5788 | |
Ar Healthcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11 E Main St Ste A, St Charles, IL 60174 Phone: 630-931-0188 Fax: 630-931-0192 | |
Michele P Thatcher Md Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2320 Dean St, Suite 201, St Charles, IL 60175 Phone: 630-377-4048 Fax: 630-377-8305 | |
Tri City Health Partnership Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 318 Walnut St, St Charles, IL 60174 Phone: 630-377-9277 | |
Fox Prairie Medical Group P C Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2560 Foxfield Rd, Suite 160, St Charles, IL 60174 Phone: 630-513-8734 | |
Best Practices Inpatient Care, Ltd. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 850 Dunham Rd, St Charles, IL 60174 Phone: 630-443-4400 |