Provider Demographics
NPI:1245226356
Name:LIEB, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LIEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5501 W 79TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1784
Mailing Address - Country:US
Mailing Address - Phone:773-884-4523
Mailing Address - Fax:773-884-4580
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:SUITE 2120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:773-726-9515
Practice Address - Fax:312-726-1681
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036050096207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050096Medicaid
IL791062505OtherRAILROAD MEDICARE
IL21607511OtherBLUE SHIELD
IL036050096Medicaid
IL791062505OtherRAILROAD MEDICARE