Provider Demographics
NPI:1801830484
Name:LIEBOW, MICHAEL RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:LIEBOW
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 1774
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1774
Mailing Address - Country:US
Mailing Address - Phone:301-581-1111
Mailing Address - Fax:301-581-1131
Practice Address - Street 1:5225 POOKS HILL RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2052
Practice Address - Country:US
Practice Address - Phone:301-581-1111
Practice Address - Fax:301-581-1131
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01397213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU89737Medicare UPIN