Individual
MICHAEL TANNER LIBSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 779-3366
Mailing address
1200 N BEAVER ST, ATTN: PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
011715
AZ
Other
Enumeration date
03/16/2019
Last updated
06/24/2025
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