Healthcare Provider Details

I. General information

NPI: 1538123724
Provider Name (Legal Business Name): LIBERTY BELLE SHELTON HOBERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 136TH AVE SUITE 416
HOLLAND MI
49424-2923
US

IV. Provider business mailing address

400 136TH AVE SUITE 416
HOLLAND MI
49424-2923
US

V. Phone/Fax

Practice location:
  • Phone: 616-738-0470
  • Fax: 616-738-0498
Mailing address:
  • Phone: 616-738-0470
  • Fax: 616-738-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301068128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: