Provider Demographics
NPI:1942648787
Name:LIEM, ANDRE C L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:C L
Last Name:LIEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BAMC
Mailing Address - Street 2:3551 ROGER BROOKE DRIVE
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:202-868-3847
Mailing Address - Fax:
Practice Address - Street 1:BAMC
Practice Address - Street 2:3551 ROGER BROOKE DRIVE
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:202-868-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1942648787208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty