Basic Information
| Provider Information | |||||||||
| NPI: | 1316933120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIEBER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 COMMERCE CT | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LISLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605323698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309681881 | ||||||||
| FaxNumber: | 6302459098 | ||||||||
| Practice Location | |||||||||
| Address1: | 4115 FAIRVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605152268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309681881 | ||||||||
| FaxNumber: | 6309683762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 036076570 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 036076570 | IL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207XX0005X | 036076570 | IL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200013541 | 01 | IL | RAILROAD MEDICARE | OTHER | 036076570 | 05 | IL | MEDICAID |