Healthcare Provider Details

I. General information

NPI: 1366880999
Provider Name (Legal Business Name): JENNIFER MARIE LIEBSCH DEANNA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PL
FLINT MI
48503-2465
US

IV. Provider business mailing address

806 TUURI PL
FLINT MI
48503-2465
US

V. Phone/Fax

Practice location:
  • Phone: 810-767-5750
  • Fax:
Mailing address:
  • Phone: 810-767-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101020583
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: