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General NPI Number Information
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NPI Number | 1205176674
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Entity Type | Organization
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Legal Business Name | MICHAEL R. LIEPMAN MD, PLLC
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 2615 STADIUM DRIVE ELIZABETH UPJOHN COMMUNITY HEALING CENTER
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City | KALAMAZOO
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State | MI
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Zip | 49008
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Country | US
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Telephone | 269-343-1651
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Fax | 269-382-7078
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Provider Business Mailing Address
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Address Line | 10925 E FG AVE
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City | RICHLAND
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State | MI
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Zip | 49083-9627
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Country | US
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Telephone | 269-598-9487
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Fax | 269-665-6553
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Authorized Official
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Title or Position | PRINCIPAL OWNER
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Name | DR. MICHAEL ROGER LIEPMAN
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Credential | M.D.
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Telephone | 269-343-1651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301033951
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License Number State | MI
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