NPIMap

Organization Active NPI

Jeffrey M Lieblich MD SC

  • Specialist
  • Highland Park, IL
National Provider Identifier
1013126614
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036047697 Issued in IL
Legal business name
JEFFREY M LIEBLICH MD SC
Practice address
1971 2ND St
Suite 100
Highland Park, IL 60035-3174
Phone
(847) 432-5510
Fax
(847) 432-5526
NPI assigned
May 21, 2007
Last updated
Dec 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey M Lieblich, M.D.,S.C.NPI 1184620916
Title
Owner
Phone
(847) 432-5510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036047697 IL Primary

Addresses

Primary practice location

1971 2ND St
Suite 100
Highland Park, IL 60035-3174

Mailing address

1971 2ND St
Suite 100
Highland Park, IL 60035-3174
Phone (847) 432-5510

Other identifiers 1

IdentifierTypeStateIssuer
036047697MedicaidIL

National Provider Directory

National Provider Directory

Locations

1971 2nd St
Ste 100
Highland Park, IL 60035
Phone (847) 432-5510

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262131200000",
    "number": "1013126614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1971 2ND ST",
            "address_2": "SUITE 100",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353174",
            "telephone_number": "847-432-5510",
            "fax_number": "847-432-5526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1971 2ND ST",
            "address_2": "SUITE 100",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353174",
            "telephone_number": "847-432-5510",
            "fax_number": "847-432-5526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY M LIEBLICH MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2009-12-30",
        "status": "A",
        "authorized_official_last_name": "LIEBLICH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-432-5510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,S.C."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036047697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036047697",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.