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Individual
DR. THOMAS LEIBOLD
Active
Individual
DR. THOMAS LEIBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301048147
MI
207Q00000X
Family Medicine Physician
Primary
4301048147
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C94735
BCBS
—
01
—
1417961137
BCBSM - BMH
MI
01
—
1770597494
BCBSM - BVH
MI
05
—
1992756456
—
MI
05
—
521519710
—
MI
Enumeration date
05/12/2006
Last updated
04/28/2011
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