Provider Demographics
NPI:1821044884
Name:LIEM SOM OEI MD PC
Entity Type:Organization
Organization Name:LIEM SOM OEI MD PC
Other - Org Name:RENAL ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-255-7746
Mailing Address - Street 1:357 W TOWER RD
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5018
Mailing Address - Country:US
Mailing Address - Phone:712-255-7746
Mailing Address - Fax:712-255-0829
Practice Address - Street 1:357 W TOWER RD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5018
Practice Address - Country:US
Practice Address - Phone:712-255-7746
Practice Address - Fax:712-255-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
098555OtherNEBRASKA MEDICARE PTAN
SDS108150OtherSOUTH DAKOTA PTAN
IA02895OtherWELLMARK
IA0028951Medicaid
CI7806OtherRAILROAD MEDICARE
CI7806OtherRAILROAD MEDICARE
IA02895OtherWELLMARK