Healthcare Provider Details

I. General information

NPI: 1942294921
Provider Name (Legal Business Name): DAVID CHRISTOPHER LIEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MARKET ST
COLUMBIA CITY IN
46725-2311
US

IV. Provider business mailing address

111 W MARKET ST
COLUMBIA CITY IN
46725-2311
US

V. Phone/Fax

Practice location:
  • Phone: 260-244-6066
  • Fax: 260-248-2348
Mailing address:
  • Phone: 260-244-6066
  • Fax: 260-248-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01053119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: