MEDICARE: LIBERATA J PANTIG 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	207R00000X	Internal Medicine Physician	4301031546	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851369722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIBERATA J PANTIG M.D.

Provider Business Mailing Address
First Line	:	1117 S VAN DYKE RD
Second Line	:	SUITE 400
City	:	BAD AXE
State	:	MI
Zip	:	48413-8467
Country	:	US
Telephone Number	:	989-269-6048
Fax Number	:	989-269-6174

Provider Business Practice Location Address
First Line	:	1117 S VAN DYKE RD
Second Line	:	SUITE 400
City	:	BAD AXE
State	:	MI
Zip	:	48413-8467
Country	:	US
Telephone Number	:	989-269-6048
Fax Number	:	989-269-6174

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/01/2010

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