Provider Demographics
NPI:1689785131
Name:LIE, ROBIN K (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:K
Last Name:LIE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2162
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-0162
Mailing Address - Country:US
Mailing Address - Phone:415-244-5478
Mailing Address - Fax:
Practice Address - Street 1:130 LA CASA VIA STE 204
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-937-2860
Practice Address - Fax:925-937-5565
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4282213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42820Medicaid
CA000E42820Medicare ID - Type Unspecified
CAEU384AMedicare PIN
CA000E42820Medicaid