Provider Demographics
NPI:1598027922
Name:JOEL M. LEIBSOHN, M.D., INC
Entity Type:Organization
Organization Name:JOEL M. LEIBSOHN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACFARLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-836-8166
Mailing Address - Street 1:19101 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6904
Mailing Address - Country:US
Mailing Address - Phone:816-836-8166
Mailing Address - Fax:816-836-3160
Practice Address - Street 1:19101 E VALLEY VIEW PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6904
Practice Address - Country:US
Practice Address - Phone:816-836-8166
Practice Address - Fax:816-836-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7571207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0003641AMedicare PIN
MO0003641Medicare PIN