MEDICARE: LIBORIO L LIRA 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	208D00000X	General Practice Physician	20943	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	:	1427054287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIBORIO L LIRA M.D.

Provider Business Mailing Address
First Line	:	226 CENTRAL AVE
Second Line	:
City	:	OSSEO
State	:	MN
Zip	:	55369-1245
Country	:	US
Telephone Number	:	763-425-2117
Fax Number	:	763-425-3935

Provider Business Practice Location Address
First Line	:	3501 DOUGLAS DR N
Second Line	:
City	:	CRYSTAL
State	:	MN
Zip	:	55422-2480
Country	:	US
Telephone Number	:	764-535-9601
Fax Number	:	763-535-5601

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/01/2013

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