Healthcare Provider Details

I. General information

NPI: 1093849127
Provider Name (Legal Business Name): ABRAHAM JOSEPH LIEBESKIND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST NEONATOLOGY
NEENAH WI
54956-2883
US

IV. Provider business mailing address

130 2ND ST NEONATOLOGY
NEENAH WI
54956-2883
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-7990
  • Fax: 920-722-4224
Mailing address:
  • Phone: 920-969-7990
  • Fax: 920-722-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number44469
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: