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1003816075

NPI Code Detail

MEDICARE: WILLIAM NATHAN LISBERG MD

MEDICARE: WILLIAM NATHAN LISBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	28413	MN
2	2085U0001X	Diagnostic Ultrasound Physician	28413	MN
3	2085B0100X	Body Imaging Physician	28413	MN
4	2085N0700X	Neuroradiology Physician	28413	MN
5	2085N0904X	Nuclear Radiology Physician	28413	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003816075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM NATHAN LISBERG MD

Provider Business Mailing Address
First Line	:	2800 CAMPUS DR
Second Line	:	#10
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-2645
Country	:	US
Telephone Number	:	763-559-2171
Fax Number	:	763-694-9000

Provider Business Practice Location Address
First Line	:	3300 OAKDALE AVE N
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2926
Country	:	US
Telephone Number	:	763-559-2171
Fax Number	:	763-694-9000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/03/2009

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Directions to “ WILLIAM NATHAN LISBERG MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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