Provider Demographics
NPI:1245472455
Name:LIEBERMAN, ELLIOT DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:DANIEL
Last Name:LIEBERMAN
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 1:1160 PARK AVE W
Mailing Address - Street 2:SUITE 4N
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2230
Mailing Address - Country:US
Mailing Address - Phone:847-433-5555
Mailing Address - Fax:847-433-9148
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:SUITE 4N
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2230
Practice Address - Country:US
Practice Address - Phone:847-433-5555
Practice Address - Fax:847-433-9148
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134151207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology