Basic Information
| Provider Information | |||||||||
| NPI: | 1902833171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LELIEVER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 K M WICKER MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273305070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197746829 | ||||||||
| FaxNumber: | 9197752327 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 KM WICKER MEMORIAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197746829 | ||||||||
| FaxNumber: | 9197752327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 10/22/2013 | ||||||||
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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 | 207Y00000X | 30932 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 237700000X | 30932 | NC | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 8951664 | 05 | NC | MEDICAID | 040001933 | 01 | NC | PALMETTO GBA-RR MEDICARE | OTHER | 3404108 | 01 | NC | MEDICAID - HEARING AID CLAIMS | OTHER |