Healthcare Provider Details

I. General information

NPI: 1629265525
Provider Name (Legal Business Name): MICHAEL J LIEBER MD A PROFESSSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD STE 1190W
SANTA MONICA CA
90404-2102
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD STE 1190W
SANTA MONICA CA
90404-2102
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-1414
  • Fax: 310-362-8775
Mailing address:
  • Phone: 310-453-1414
  • Fax: 310-362-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG32244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG32244
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL JONATHAN LIEBER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-453-1414