| Doctor Name: | DR. ANDRE C. L. LIEM |
| NPI Number: | 1942648787 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 28143 |
| Business Practice Address: | 3504 Georgia Ave Ctmc, Bldg 3504 Fort Polk, LA - 714595110 |
| Business Phone Number: | 3375340297 |
| Business Fax Number: | |
| Mailing Address: | 3504 Georgia Ave, Ctmc, Bldg 3504 FORT POLK |
| State: | LA |
| Postal Code: | 714595110 |
| Phone Number: | 3375340297 |
| Fax Number: | |
| NPI Enumeration Date: | 06/13/2013 |
| NPI Last Update Date: | 12/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 28143 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |