Healthcare Provider Details

I. General information

NPI: 1265531172
Provider Name (Legal Business Name): MICHAEL EDMOND LIEPPMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE #107
LONG BEACH CA
90804-2105
US

IV. Provider business mailing address

1760 TERMINO AVE #107
LONG BEACH CA
90804-2105
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-5511
  • Fax: 562-498-9429
Mailing address:
  • Phone: 562-597-5511
  • Fax: 562-498-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG032245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: