OrganizationKenneth J Liesen Md ScFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address606 Riverside Ave, St Charles, IL 60174-2969(630) 584-8900PECOS EnrollmentBased on the most recent information from CMS, provider Kenneth J Liesen Md Sc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1124223763Provider TypeOrganizationFull NameKenneth J Liesen Md ScSubpartNoEnumeration Date6/15/2007Last Updated1/17/2014Contact InformationPractice LocationPractice Address606 Riverside Ave, St Charles, IL 60174-2969Phone(630) 584-8900Fax(630) 584-2806Mailing LocationMailing Address606 Riverside Ave, St Charles, IL 60174-2969Phone(630) 584-8900Fax(630) 584-2806Authorized OfficialNameLiesen, Kenneth J (Medical Doctor)Phone(630) 584-8900Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense036077277IllinoisProvider IdentifiersIDDescriptionIssuerID036077277DescriptionMedicaidIssuerUnlistedIllinoisID966700DescriptionOtherIssuerINDIVIDUAL MEDICARE PTANIllinoisID036077277DescriptionOtherIssuerBCBSIllinoisID943790DescriptionOtherIssuerGROUP PTANIllinois