Healthcare Provider Details

I. General information

NPI: 1245226356
Provider Name (Legal Business Name): DAVID LIEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE SUITE 2120
CHICAGO IL
60602-1903
US

IV. Provider business mailing address

5501 W 79TH ST SUITE 400
BURBANK IL
60459-1784
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-9515
  • Fax: 312-726-1681
Mailing address:
  • Phone: 773-884-4523
  • Fax: 773-884-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036050096
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: