MEDICARE: DR. MARK JOSEPH LUEBBERS M.D.

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	207R00000X	Internal Medicine Physician	35052371	OH

General Provider Information

NPI Number	:	1235145921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JOSEPH LUEBBERS M.D.

Provider Business Mailing Address
First Line	:	400 BROADWAY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-3312
Country	:	US
Telephone Number	:	513-629-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 BROADWAY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-3312
Country	:	US
Telephone Number	:	513-629-1502
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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