Provider Demographics
NPI:1255410288
Name:MICHELE F LIBMAN MD PA
Entity type:Organization
Organization Name:MICHELE F LIBMAN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-419-0560
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-419-0560
Mailing Address - Fax:772-419-0557
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:STE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-419-0560
Practice Address - Fax:772-419-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB906SOtherBCBS
FLQ0428Medicare PIN
FLB906SOtherBCBS