Healthcare Provider Details

I. General information

NPI: 1144585787
Provider Name (Legal Business Name): LIA SIBILSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIA JOSEPH

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 S CEDAR ST
LANSING MI
48911-3800
US

IV. Provider business mailing address

812 E JOLLY RD STE 311
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8062
  • Fax: 517-346-8011
Mailing address:
  • Phone: 517-346-8275
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801092071
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: