Healthcare Provider Details

I. General information

NPI: 1801884853
Provider Name (Legal Business Name): STACEY B LEIBOWITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 SW 47TH AVE
CORAL GABLES FL
33143-6250
US

IV. Provider business mailing address

7730 SW 47TH AVE
CORAL GABLES FL
33143-6250
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-6280
  • Fax:
Mailing address:
  • Phone: 305-661-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME114813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: