Healthcare Provider Details

I. General information

NPI: 1245337690
Provider Name (Legal Business Name): NAZZARENO LIEGGHIO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG BLDG 10-217
BATTLE CREEK MI
49016
US

IV. Provider business mailing address

5500 ARMSTRONG BLDG 10-217
BATTLE CREEK MI
49016
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax: 269-966-5592
Mailing address:
  • Phone: 269-966-5600
  • Fax: 269-966-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101008627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: