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KENNETH J LIESEN MD SC
NPI 1124223763
Family Medicine in St Charles, IL

Active since June 15, 2007
606 RIVERSIDE AVE, ST CHARLES, IL 60174(630) 584-8900(630) 584-2806 Get Directions Write a Review

NPPES record last updated: January 17, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kenneth J Liesen Md Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH J LIESEN MD SC (NPI 1124223763) is a healthcare organization registered as a family medicine in St Charles, Illinois and active in the NPI registry since June 2007. The organization lists Kenneth J Liesen, Medical Doctor, as its authorized official.

NPPES Registry Identity

NPI1124223763
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameKENNETH J LIESEN MD SC
Location Address606 RIVERSIDE AVESt Charles, IL 60174-2969
Mailing Address606 Riverside AveSt Charles, IL 60174-2969 · (630) 584-8900 · Fax (630) 584-2806
Phone(630) 584-8900
Fax(630) 584-2806
Organization SubpartNo
Authorized OfficialKenneth J LiesenMedical Doctor · (630) 584-8900
Enumeration DateJune 15, 2007
Last NPPES UpdateJanuary 17, 2014
✔ NPI 1124223763 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IL · 036077277
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
606 RIVERSIDE AVE, St Charles, IL 60174
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Other Identifiers 5

Other943790IL · Group Ptan
Medicaid036077277IL
Other036077277IL · Bcbs
Other966700IL · Individual Medicare Ptan
Medicare UPINE40247IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0416588

Kenneth J Liesen MD Sc · Geneva, IL
Expired · Jul 20, 2026
CLIA Number14D0416588
Laboratory TypePhysician Office
Certificate Effective DateJuly 21, 2024
Certificate Expiration DateJuly 20, 2026
Laboratory DirectorKenneth J. Liesen M D
Laboratory Phone(630) 584-8900
Laboratory LocationKenneth J Liesen MD Sc1665 South St, Geneva, IL 60134
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTIN BAUMLER DMD
Dentist (General Practice)
606 RIVERSIDE AVE
ST CHARLES, IL 60174
Kane County (630) 584-5920
COMPREHENSIVE DENTISTRY
Clinic/Center (Dental)
606 RIVERSIDE AVE, SUITE C
ST CHARLES, IL 60174
Kane County (630) 584-5920

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth J Liesen MD Sc's NPI number?

The NPI number for Kenneth J Liesen MD Sc is 1124223763. It was assigned to this organization in the NPPES registry on June 15, 2007.

Where is Kenneth J Liesen MD Sc located?

Kenneth J Liesen MD Sc is located at 606 Riverside Ave, St Charles, IL 60174. The listed phone number is (630) 584-8900.

What is Kenneth J Liesen MD Sc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Kenneth J Liesen MD Sc was last updated on January 17, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.