KENNETH J LIESEN MD SC NPI 1124223763

NPI Information

  • NPI: 1124223763
  • Provider Name: KENNETH J LIESEN MD SC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 606 RIVERSIDE AVE
    ST CHARLES, IL
    ZIP 60174
  • Phone: (630) 584-8900

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NPI Details

KENNETH J LIESEN MD SC is a family medicine in St Charles, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. KENNETH J LIESEN MD SC NPI is 1124223763. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

606 RIVERSIDE AVE
ST CHARLES, IL
ZIP 60174-969
Phone: (630) 584-8900
Fax: (630) 584-2806

The provider's authorized official is Kenneth J Liesen .
The authorized official title is Medical Doctor and has the following contact phone number (630) 584-8900.

The enumeration date for this NPI number is 6/15/2007 and was last updated on 1/17/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine036077277ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1943790OTHERILLINOISGROUP PTAN
2036077277MEDICAIDILLINOIS
3036077277OTHERILLINOISBCBS
4966700OTHERILLINOISINDIVIDUAL MEDICARE PTAN
5E40247MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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