Healthcare Provider Details

I. General information

NPI: 1972766632
Provider Name (Legal Business Name): HOWARD M LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 16960
MIAMI FL
33101-6960
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6837
  • Fax:
Mailing address:
  • Phone: 305-243-8470
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME102081
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME102081
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME102081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: