Provider Demographics
NPI:1518302181
Name:LIBERMAN, DANIEL (MDCM)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:MDCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STEET SE, MMC 394
Mailing Address - Street 2:DANIEL LIBERMAN MD
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0346
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:651-999-6830
Practice Address - Street 1:420 DELAWARE STRE SE, SUITE B435
Practice Address - Street 2:INSTITUTE FOR PROSTRATE AND UROLOGIC CANCERS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6830
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2014-04-29
Deactivation Date:2014-02-20
Deactivation Code:
Reactivation Date:2014-04-29
Provider Licenses
StateLicense IDTaxonomies
MN56194390200000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program