Provider Demographics
NPI:1851369722
Name:PANTIG, LIBERATA J (MD)
Entity Type:Individual
Prefix:
First Name:LIBERATA
Middle Name:J
Last Name:PANTIG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1117 S VAN DYKE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8467
Mailing Address - Country:US
Mailing Address - Phone:989-269-6048
Mailing Address - Fax:989-269-6174
Practice Address - Street 1:1117 S VAN DYKE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8467
Practice Address - Country:US
Practice Address - Phone:989-269-6048
Practice Address - Fax:989-269-6174
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-09-01
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Provider Licenses
StateLicense IDTaxonomies
MI4301031546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675512Medicaid
MI231316Medicare Oscar/Certification