MEDICARE: MARK A LEIBEL MD

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	207Q00000X	Family Medicine Physician	44836	WI
2	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	44836	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080190901	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WI01N2	OTHER	WI	JOHN DEERE
2	390807236A3	OTHER	WI	UNITY
3	44836	OTHER	WI	TOUCHPOINT
5	13311	OTHER	WI	DEAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689655995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A LEIBEL MD

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HIGHLAND AVE
Second Line	:	B6/319 CSC
City	:	MADISON
State	:	WI
Zip	:	53792-3272
Country	:	US
Telephone Number	:	608-263-8100
Fax Number	:

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/16/2013

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Directions to “ MARK A LEIBEL MD” Practice Location

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