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Individual

MATTHEW AARON LIEBENTRITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
12169 SHERIDAN BLVD, BROOMFIELD, CO 80020-2459
(303) 603-9400
(303) 603-9420
Mailing address
12169 SHERIDAN BLVD, BROOMFIELD, CO 80020-2459
(303) 603-9400
(303) 603-9420

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41855
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
82778868
CO
01
P00462907
MEDICARE RAILROAD
Enumeration date
11/28/2006
Last updated
06/25/2012
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