Provider Demographics
NPI:1639172844
Name:LALIBERTE, MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LALIBERTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0757
Mailing Address - Country:US
Mailing Address - Phone:407-523-9993
Mailing Address - Fax:407-347-0690
Practice Address - Street 1:1554 BOREN DR STE 400
Practice Address - Street 2:SUITE 400
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2986
Practice Address - Country:US
Practice Address - Phone:407-523-9993
Practice Address - Fax:407-347-0690
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1795213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340618100Medicaid
FLT19700Medicare UPIN
FL65026Medicare ID - Type Unspecified