Provider Demographics
NPI:1093752925
Name:QUIROZ, LIESCHEN H (MD)
Entity Type:Individual
Prefix:
First Name:LIESCHEN
Middle Name:H
Last Name:QUIROZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SL YOUNG BLVD, WP 2430
Mailing Address - Street 2:
Mailing Address - City:OKALHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4313
Mailing Address - Country:US
Mailing Address - Phone:405-271-7449
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 13TH ST
Practice Address - Street 2:ORI 274B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1039
Practice Address - Country:US
Practice Address - Phone:405-271-1515
Practice Address - Fax:405-271-1001
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62954207V00000X
OK26218207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408412800Medicaid
MDH775JOMedicare ID - Type Unspecified
MDI41269Medicare UPIN
MDM306Medicare ID - Type Unspecified