Individual
DR. MATTHEW A R LIBIRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 WEST CHICAGO AVENUE, SUITE F, EAST CHICAGO, IN 46312-3260
(219) 397-0193
(219) 397-0657
Mailing address
100 WEST CHICAGO AVENUE, SUITE F, EAST CHICAGO, IN 46312-3260
(219) 397-0193
(219) 397-0657
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01059738A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01059738A
MEDICAL LICENSE
—
05
—
200531170
—
IN
Enumeration date
08/22/2005
Last updated
11/29/2012
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