Healthcare Provider Details

I. General information

NPI: 1306082094
Provider Name (Legal Business Name): MAX LIEBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE CARDIOLOGY-BLDG.110, RM. 6269
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE CARDIOLOGY-BLDG.110, RM. 6269
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-327-2738
  • Fax: 708-327-2773
Mailing address:
  • Phone: 708-327-2738
  • Fax: 708-327-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036133585
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: