Healthcare Provider Details

I. General information

NPI: 1750513099
Provider Name (Legal Business Name): JUSTIN K LIEGMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 ALI DR DEPT 320
GRAND BLANC MI
48439-5193
US

IV. Provider business mailing address

5445 ALI DR DEPT 320
GRAND BLANC MI
48439-5193
US

V. Phone/Fax

Practice location:
  • Phone: 810-428-1181
  • Fax: 810-426-0009
Mailing address:
  • Phone: 810-428-2011
  • Fax: 810-426-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number4301097584
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301097584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: