Provider Demographics
NPI:1942294921
Name:LIEB, DAVID CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:LIEB
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 1:111 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-2311
Mailing Address - Country:US
Mailing Address - Phone:260-244-6066
Mailing Address - Fax:260-248-2348
Practice Address - Street 1:111 W MARKET ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-2311
Practice Address - Country:US
Practice Address - Phone:260-244-6066
Practice Address - Fax:260-248-2348
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053119A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2002238790BMedicaid
IN189030Medicare PIN
INH30285Medicare UPIN