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General NPI Number Information
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NPI Number | 1013126614
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Entity Type | Organization
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Legal Business Name | JEFFREY M LIEBLICH MD SC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 1971 2ND ST SUITE 100
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3174
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Country | US
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Telephone | 847-432-5510
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Fax | 847-432-5526
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Provider Business Mailing Address
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Address Line | 1971 2ND ST SUITE 100
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3174
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Country | US
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Telephone | 847-432-5510
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Fax | 847-432-5526
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY M LIEBLICH
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Credential | M.D.,S.C.
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Telephone | 847-432-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036047697
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License Number State | IL
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