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NPI Code Detail

MEDICARE: MRS. GINA T LIBERMAN

MEDICARE:  MRS. GINA T LIBERMAN
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
1124Q00000XDental Hygienist020.013763IL

General Provider Information

NPI Number : 1912288846
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GINA T LIBERMAN
Provider Business Mailing Address
First Line : 694 CHIPPEWA CIR
Second Line :
City : ROUND LAKE HEIGHTS
State : IL
Zip : 60073-1181
Country : US
Telephone Number : 847-774-3748
Fax Number :
Provider Business Practice Location Address
First Line : 694 CHIPPEWA CIR
Second Line :
City : ROUND LAKE HEIGHTS
State : IL
Zip : 60073-1181
Country : US
Telephone Number : 847-774-3748
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2011
Last Update Date : 09/06/2011

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Directions to “ MRS. GINA T LIBERMAN ” Practice Location

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