Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD0598906 | PA |
N | 208600000X | Surgeon | MD0598906 | PA |
N | 2086S0120X | Pediatric Surgery | 20817 | MS |
Y | 2086S0120X | Pediatric Surgery | DR.0054069 | CO |
NPI | 1588752836 |
---|---|
Provider Name | Dr. Kenneth W Liechty |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 10/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H81875 | (02) | PA |