Provider Demographics
NPI:1033173901
Name:LIEBERMAN, ISADOR H (MD)
Entity Type:Individual
Prefix:
First Name:ISADOR
Middle Name:H
Last Name:LIEBERMAN
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 1:6020 W PARKER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8171
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072842L207X00000X
FLME100364207XS0117X
NY2292351207XS0117X
CAA85601207XS0117X
PAMD418431207XS0117X
IL036.106531207XS0117X
CT041358207XS0117X
MI4301079354207XS0117X
TXN5808207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136576Medicaid
TX214998101Medicaid
TXTXB104177Medicare UPIN
TX214998101Medicaid
OHLI7361791Medicare PIN