Provider Demographics
NPI:1508086430
Name:LIBBEY, MICHAEL JUDE SR (RD,CDE)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JUDE
Last Name:LIBBEY
Suffix:SR
Gender:M
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WOODVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4645
Mailing Address - Country:US
Mailing Address - Phone:330-881-6439
Mailing Address - Fax:330-726-5465
Practice Address - Street 1:72 WOODVIEW AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4645
Practice Address - Country:US
Practice Address - Phone:330-881-6439
Practice Address - Fax:330-726-5465
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 2524133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered