Provider Demographics
NPI:1205176674
Name:MICHAEL R. LIEPMAN MD, PLLC
Entity type:Organization
Organization Name:MICHAEL R. LIEPMAN MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LIEPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-343-1651
Mailing Address - Street 1:10925 E FG AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9627
Mailing Address - Country:US
Mailing Address - Phone:269-598-9487
Mailing Address - Fax:269-665-6553
Practice Address - Street 1:2615 STADIUM DRIVE
Practice Address - Street 2:ELIZABETH UPJOHN COMMUNITY HEALING CENTER
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008
Practice Address - Country:US
Practice Address - Phone:269-343-1651
Practice Address - Fax:269-382-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010339512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4184022Medicaid
MI4184022Medicaid