Basic Information
| Provider Information | |||||||||
| NPI: | 1205176674 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL R. LIEPMAN MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10925 E FG AVE | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490839627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695989487 | ||||||||
| FaxNumber: | 2696656553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 STADIUM DRIVE | ||||||||
| Address2: | ELIZABETH UPJOHN COMMUNITY HEALING CENTER | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693431651 | ||||||||
| FaxNumber: | 2693827078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2013 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | LIEPMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | ROGER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRINCIPAL OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2693431651 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 4301033951 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4184022 | 05 | MI | MEDICAID |