Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 24157 | NE |
Y | 2080P0202X | Pediatric Cardiologist | 7365826-1205 | UT |
NPI | 1023229051 |
---|---|
Provider Name | Kirk N. Liesemer |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 06/01/2022 |