Healthcare Provider Details

I. General information

NPI: 1902825771
Provider Name (Legal Business Name): SUSAN G LIEBOVITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W. HIGGINS ROAD SUITE 1040
HOFFMAN ESTATES IL
60169
US

IV. Provider business mailing address

2500 W. HIGGINS ROAD SUITE 1040
HOFFMAN ESTATES IL
60169
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-8096
  • Fax: 847-884-8125
Mailing address:
  • Phone: 847-884-8096
  • Fax: 847-884-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: