Healthcare Provider Details

I. General information

NPI: 1639697287
Provider Name (Legal Business Name): CALEB PAUL LIEBING PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVENUE SU. 201
CINCINNATI OH
45219
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT 2ND FLOOR, CBO 2-3
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1170
  • Fax: 513-206-1172
Mailing address:
  • Phone: 513-206-1170
  • Fax: 513-206-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005229RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: