Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001147 | MI |
Y | 222Z00000X | Podiatrist | 5901001147 | MI |
NPI | 1043248792 |
---|---|
Provider Name | Dr. Clifford Laliberte |
First Address | Clarkston, MI 48346-3149 |
Second Address | Clarkston, MI 48346-3149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 08/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U33250 | (02) | MI |