Liedtke, Eric E.

Liedtke, Eric E. is an individual health care provider with primary practice located at 4650 Harrison Blvd , Ogden UT 84403-4303. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Liedtke, Eric E. can be contacted via phone (801) 475-3010.

Contact Information

Primary practice address
4650 Harrison Blvd Ogden UT 84403-4303
Phone: (801) 475-3010
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 20A12096 California
Allopathic & Osteopathic Physicians / Surgery 208600000X OP60582410 Washington
Allopathic & Osteopathic Physicians / Surgery 208600000X 12168421-1204 Utah

Profile Details

NPI number 1366624330
LBN Legal business name Liedtke, Eric E.
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 3rd, 2007
Last updated Jun 15th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366624330 NPPES
Utah MEDICAID 1366624330
Utah Other P01526646

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