Provider Demographics
NPI:1548351687
Name:LIESMAN, ROBERT M (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:LIESMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 E 7TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3307
Mailing Address - Country:US
Mailing Address - Phone:704-442-8433
Mailing Address - Fax:704-817-9957
Practice Address - Street 1:2115 E 7TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3307
Practice Address - Country:US
Practice Address - Phone:704-442-8433
Practice Address - Fax:704-817-9957
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC356213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908158Medicaid
NC0268LOtherBCBS
NC2335786Medicare ID - Type Unspecified
NC8908158Medicaid