Basic Information
| Provider Information | |||||||||
| NPI: | 1821044884 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIEM SOM OEI MD PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | RENAL ASSOCIATES PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 357 W TOWER RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122557746 | ||||||||
| FaxNumber: | 7122550829 | ||||||||
| Practice Location | |||||||||
| Address1: | 357 W TOWER RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122557746 | ||||||||
| FaxNumber: | 7122550829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | TERI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7122557746 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 098555 | 01 | NEBRASKA MEDICARE PTAN | OTHER | S108150 | 01 | SD | SOUTH DAKOTA PTAN | OTHER | 02895 | 01 | IA | WELLMARK | OTHER | 0028951 | 05 | IA | MEDICAID | CI7806 | 01 | RAILROAD MEDICARE | OTHER |