Provider Demographics
NPI:1639697287
Name:LIEBING, CALEB PAUL (PA)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:PAUL
Last Name:LIEBING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT 2ND FLOOR, CBO 2-3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-206-1170
Mailing Address - Fax:513-206-1172
Practice Address - Street 1:2123 AUBURN AVENUE SU. 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-206-1170
Practice Address - Fax:513-206-1172
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005229RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant