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WALTER DICKINSON LIEBKEMANN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1331 N ELM ST STE 200, GREENSBORO, NC 27401-6304
(336) 274-6682
(336) 274-8097
Mailing address
PO BOX 85378, CHICAGO, IL 60689-5378
(336) 274-6682
(336) 274-8097

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
9701459
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1130Y
BLUE CROSS BLUE SHIELD
NC
05
1376526434
VA
01
1608405
UNITED HEALTHCARE
NC
01
300111715
RAILROAD MEDICARE
NC
05
891130Y
NC
01
98523
MEDCOST
NC
Enumeration date
11/22/2005
Last updated
10/01/2025
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