Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019029781 | IL |
N | 122300000X | Dentist | 2901021171 | MI |
N | 1223P0221X | Pediatric Dentist | 021002603 | IL |
Y | 1223P0221X | Pediatric Dentist | 060287 | NY |
N | 1223P0221X | Pediatric Dentist | DS040221 | PA |
NPI | 1003161191 |
---|---|
Provider Name | Dr. Michael Brian Lieberman |
First Address | New York, NY 10023-5043 |
Second Address | Farmington Hills, MI 48331-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 20/08/2019 |