MEDICARE: ALEC LIEDERBACH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	11431	FL

General Provider Information

NPI Number	:	1205769288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEC LIEDERBACH DO

Provider Business Mailing Address
First Line	:	264 E ROLLINS STREET
Second Line	:	6TH FLOOR
City	:	ORLANDO
State	:	FL
Zip	:	32808-5519
Country	:	US
Telephone Number	:	407-303-6729
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 E ROLLINS STREET
Second Line	:	6TH FLOOR
City	:	ORLANDO
State	:	FL
Zip	:	32808-5519
Country	:	US
Telephone Number	:	407-303-6729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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