MEDICARE: STACEY B LEIBOWITZ 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	207RX0202X	Medical Oncology Physician	ME114813	FL

General Provider Information

NPI Number	:	1801884853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY B LEIBOWITZ M.D.

Provider Business Mailing Address
First Line	:	7730 SW 47TH AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-6250
Country	:	US
Telephone Number	:	305-661-6280
Fax Number	:

Provider Business Practice Location Address
First Line	:	7730 SW 47TH AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-6250
Country	:	US
Telephone Number	:	305-661-6280
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	09/16/2025

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