Provider Demographics
NPI:1295977379
Name:LIEBER, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:LIEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1441 EASTLAKE AVE
Mailing Address - Street 2:RM. 5428
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0112
Mailing Address - Country:US
Mailing Address - Phone:323-865-0568
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:RM. 5428
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-9176
Practice Address - Country:US
Practice Address - Phone:323-865-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65451207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology