Provider Demographics
NPI:1922448299
Name:LIEBELT, JARED JON (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:JON
Last Name:LIEBELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PFINGSTEN RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1326
Mailing Address - Country:US
Mailing Address - Phone:847-864-3278
Mailing Address - Fax:847-657-1898
Practice Address - Street 1:2150 PFINGSTEN RD STE 1200
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1326
Practice Address - Country:US
Practice Address - Phone:847-864-3278
Practice Address - Fax:847-657-1898
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142878207RC0000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program