Provider Demographics
NPI:1508122540
Name:LEIBOWITZ, MICHAEL SHINICHI (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHINICHI
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:527 S 42ND ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4451
Mailing Address - Country:US
Mailing Address - Phone:412-298-6464
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-5179
Practice Address - Fax:720-777-7279
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT2078452080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology