Provider Demographics
NPI:1467492983
Name:FOOT AND ANKLE SPECIALISTS OF MD, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-581-1111
Mailing Address - Street 1:PO BOX 1774
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1774
Mailing Address - Country:US
Mailing Address - Phone:301-581-1111
Mailing Address - Fax:301-581-1131
Practice Address - Street 1:5225 POOKS HILL RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2052
Practice Address - Country:US
Practice Address - Phone:301-581-1111
Practice Address - Fax:301-581-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01397213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU89737Medicare UPIN