Provider Demographics
NPI:1457336851
Name:LIEFER, ALLAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
Last Name:LIEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 OLD PLANK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1153
Mailing Address - Country:US
Mailing Address - Phone:618-826-2388
Mailing Address - Fax:618-826-5139
Practice Address - Street 1:1900 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1116
Practice Address - Country:US
Practice Address - Phone:618-826-2388
Practice Address - Fax:618-826-3194
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3646019208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3646019Medicaid
231110Medicare PIN
D10038Medicare UPIN