Healthcare Provider Details

I. General information

NPI: 1558591305
Provider Name (Legal Business Name): LILIANE HOBEIKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-4600
  • Fax: 215-707-9697
Mailing address:
  • Phone: 215-707-4600
  • Fax: 215-707-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD465327
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: