Healthcare Provider Details

I. General information

NPI: 1316137383
Provider Name (Legal Business Name): MATTHEW C G LIWSKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S MERCER ST 4TH FLOOR JAMESON SOUTH
NEW CASTLE PA
16101-4672
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 724-654-5433
  • Fax: 724-654-3278
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005768
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: