Individual
DR. JACK L LIEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3931 LOUISIANA AVE S, STE E400, ST LOUIS PARK, MN 55426-4375
(952) 993-3230
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24488
MN
Other
Enumeration date
12/14/2005
Last updated
03/02/2012
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