Provider Demographics
NPI:1265531172
Name:LIEPPMAN, MICHAEL EDMOND (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDMOND
Last Name:LIEPPMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1760 TERMINO AVE
Mailing Address - Street 2:#107
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2105
Mailing Address - Country:US
Mailing Address - Phone:562-597-5511
Mailing Address - Fax:562-498-9429
Practice Address - Street 1:1760 TERMINO AVE
Practice Address - Street 2:#107
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2105
Practice Address - Country:US
Practice Address - Phone:562-597-5511
Practice Address - Fax:562-498-9429
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-02-03
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Provider Licenses
StateLicense IDTaxonomies
CAG032245207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6467Medicare ID - Type Unspecified
CAA45072Medicare UPIN