Provider Demographics
NPI:1982022943
Name:LIEDKE, CHRISTOPHER DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:LIEDKE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:147 BEACH RD STE D
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1733
Mailing Address - Country:US
Mailing Address - Phone:631-405-3325
Mailing Address - Fax:631-237-3164
Practice Address - Street 1:147 BEACH RD STE D
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1733
Practice Address - Country:US
Practice Address - Phone:631-405-3325
Practice Address - Fax:631-237-3164
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-48374207RR0500X
WAOP61495039207RR0500X
NY292906207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology