Provider Demographics
NPI:1336127737
Name:LIES, MARILYN J (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:LIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3701 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50707-1129
Mailing Address - Country:US
Mailing Address - Phone:319-274-7060
Mailing Address - Fax:319-233-1156
Practice Address - Street 1:3701 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:EVANSDALE
Practice Address - State:IA
Practice Address - Zip Code:50707-1129
Practice Address - Country:US
Practice Address - Phone:319-274-7060
Practice Address - Fax:319-233-1156
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA24244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080078033OtherRR MEDICARE
IA1336127737Medicaid
IA0030262Medicaid
IA54417Medicare PIN
IA080078033OtherRR MEDICARE