Provider Demographics
NPI:1336512268
Name:LIBURDI, EMILY (DIPL OM RAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LIBURDI
Suffix:
Gender:F
Credentials:DIPL OM RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8989 18 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-3206
Mailing Address - Country:US
Mailing Address - Phone:586-489-8867
Mailing Address - Fax:
Practice Address - Street 1:45163 CASS AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5508
Practice Address - Country:US
Practice Address - Phone:586-221-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist