Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | RL005513 | MI |
Y | 213ER0200X | Radiology | RL005513 | MI |
NPI | 1619035490 |
---|---|
Provider Name | Ronald Harlan Liedel JR. |
First Address | Flat Rock, MI 48134-1659 |
Second Address | Flat Rock, MI 48134-1659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 29/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0Q25033 | (02) | MI |
3302328 | (05) | MI |