Provider Demographics
NPI:1356310379
Name:TIBBE, LAURA JILL (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JILL
Last Name:TIBBE
Suffix:
Gender:F
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:PO BOX 4125
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025
Mailing Address - Country:US
Mailing Address - Phone:812-637-2082
Mailing Address - Fax:812-637-1103
Practice Address - Street 1:24129 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-7603
Practice Address - Country:US
Practice Address - Phone:812-496-8773
Practice Address - Fax:812-637-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054918A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349640Medicaid
OH0941324Medicaid
080178627Medicare PIN
IN186000Medicare PIN
IN200349640Medicaid
IN172580FFMedicare PIN