Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 0101252774 | VA |
N | 207RC0000X | Internist - Cardiovascular Disease | 127613 | IL |
NPI | 1194864157 |
---|---|
Provider Name | Katherine Lietz |
First Address | Riverside, IL 60546-2644 |
Second Address | Maywood, IL 60153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 17/05/2018 |