Basic Information
| Provider Information | |||||||||
| NPI: | 1295780229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OEI | ||||||||
| FirstName: | LIEM | ||||||||
| MiddleName: | SOM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1444 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122557746 | ||||||||
| FaxNumber: | 7122550829 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 4TH STREET | ||||||||
| Address2: | STE 410 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122557746 | ||||||||
| FaxNumber: | 7122550829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 20600 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 880380300 | 05 | MN | MEDICAID | 110000452 | 01 | RAILROAD MEDICARE | OTHER | 0102717 | 05 | IA | MEDICAID |