Provider Demographics
NPI:1467942227
Name:LIED, INGER JOHANNE (MD)
Entity Type:Individual
Prefix:
First Name:INGER
Middle Name:JOHANNE
Last Name:LIED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2055 KIMBALL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5047
Mailing Address - Country:US
Mailing Address - Phone:319-272-2112
Mailing Address - Fax:319-272-2107
Practice Address - Street 1:630 N ARROWLEAF TRL
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2610
Practice Address - Country:US
Practice Address - Phone:541-549-1318
Practice Address - Fax:541-588-6002
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-11105207Q00000X
ORMD203802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine