Individual
DAVID LIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 N WABASH AVE, SUITE 2120, CHICAGO, IL 60602-1903
(773) 726-9515
(312) 726-1681
Mailing address
5501 W 79TH ST, SUITE 400, BURBANK, IL 60459-1784
(773) 884-4523
(773) 884-4580
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036050096
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036050096
—
IL
01
—
21607511
BLUE SHIELD
IL
01
—
791062505
RAILROAD MEDICARE
IL
Enumeration date
09/23/2005
Last updated
10/21/2014
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