Healthcare Provider Details

I. General information

NPI: 1316174618
Provider Name (Legal Business Name): CHRISTOPHER W LIEBIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MARKET ST STE 300
BOARDMAN OH
44512-6778
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8260
  • Fax: 330-543-3851
Mailing address:
  • Phone: 330-543-8260
  • Fax: 330-543-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number35.099771
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: