Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 66283 | WI |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 66283 | WI |
NPI | 1205132321 |
---|---|
Provider Name | Dr. David Albert Liebelt |
First Address | Neenah, WI 54956-3070 |
Second Address | Appleton, WI 54911-3483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 26/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201236820 | (05) | IN |