MEDICARE: DR. MICHAEL EDMOND LIEPPMAN M.D.

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	207W00000X	Ophthalmology Physician	G032245	CA

General Provider Information

NPI Number	:	1265531172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EDMOND LIEPPMAN M.D.

Provider Business Mailing Address
First Line	:	1760 TERMINO AVE
Second Line	:	#107
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2105
Country	:	US
Telephone Number	:	562-597-5511
Fax Number	:	562-498-9429

Provider Business Practice Location Address
First Line	:	1760 TERMINO AVE
Second Line	:	#107
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2105
Country	:	US
Telephone Number	:	562-597-5511
Fax Number	:	562-498-9429

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/03/2012

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