Provider Demographics
NPI:1629265525
Name:MICHAEL J LIEBER MD A PROFESSSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL J LIEBER MD A PROFESSSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:LIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-453-1414
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:STE 1190W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-453-1414
Mailing Address - Fax:310-362-8775
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:STE 1190W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-1414
Practice Address - Fax:310-362-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32244207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14102Medicare PIN
CAA45071Medicare UPIN