Healthcare Provider Details

I. General information

NPI: 1154454007
Provider Name (Legal Business Name): MICHAEL A GLEIBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PALM BEACH LAKES BOULEVARD SUITE 950
WEST PALM BEACH FL
33401
US

IV. Provider business mailing address

1555 PALM BEACH LAKES BOULEVARD SUITE 950
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 561-972-6464
  • Fax: 561-972-6515
Mailing address:
  • Phone: 561-972-6464
  • Fax: 561-972-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036121153
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME 100716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: