Basic Information
| Provider Information | |||||||||
| NPI: | 1316441264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIEBSCHER | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | COLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 S EAST AVE APT 2 | ||||||||
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| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603042104 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF KANSAS MEDICAL CENTER 3901 RAINBOW BLVD | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135885000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2018 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.