Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036.149833 | IL |
N | 207N00000X | Dermatologist | 62406 | MN |
NPI | 1033505243 |
---|---|
Provider Name | Walter Liszewski |
First Address | Chicago, IL 60611-2997 |
Second Address | Chicago, IL 60611-2997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 29/07/2019 |