Provider Demographics
NPI:1629097654
Name:LIEBESKIND, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LIEBESKIND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:FJELSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54957-1050
Mailing Address - Country:US
Mailing Address - Phone:920-915-2584
Mailing Address - Fax:
Practice Address - Street 1:1524 S COMMERCIAL ST STE 2N
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4999
Practice Address - Country:US
Practice Address - Phone:844-547-4343
Practice Address - Fax:844-885-9574
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44592208000000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice