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General NPI Number Information
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NPI Number | 1821256710
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Entity Type | Individual
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Provider Name | MAX E LIEBL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 440-465-3546
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 440-465-3546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036.125582
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | A119951
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License Number State | CA
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