Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | P3030 | TX |
NPI | 1073615977 |
---|---|
Provider Name | Kyle Lieppman |
First Address | Austin, TX 78723-3079 |
Second Address | Austin, TX 78723-3079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 18/07/2012 |