Individual
JEFFRIE C LEIBOVITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9505 E 59TH ST STE A, INDIANAPOLIS, IN 46216-2254
(317) 545-0505
(317) 545-0506
Mailing address
9505 E 59TH ST STE A, INDIANAPOLIS, IN 46216-2254
(317) 545-0505
(317) 545-0506
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000550A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000002077
MPLAN IDENTIFIER
IN
01
—
00000313730
ANTHEM BCBS ID #
IN
01
—
1006619
TRICARE IDENTIFIER
IN
01
—
35-1619801
TAX ID #
IN
01
—
480003471
MEDICARE RAILROAD #
IN
Enumeration date
11/08/2005
Last updated
03/06/2026
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