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2000 Grant Ave Suite 102 Philadelphia PA 19115-4378 | |
| (215) 464-7222 | |
| (215) 464-6025 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 2000 Grant Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Michael Lieb (OWNER) |
| Authorized Official Contact | 2154647222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2000 Grant Ave Suite 102 Philadelphia PA 19115-4378 Ph: (215) 464-7222 | 2000 Grant Ave Suite 102 Philadelphia PA 19115-4378 Ph: (215) 464-7222 |
| NPI Number | 1811191588 |
|---|---|
| Provider Enumeration Date | 06/14/2007 |
| Last Update Date | 07/25/2016 |
| Medicare PECOS PAC ID | 2567595929 |
|---|---|
| Medicare Enrollment ID | O20100805000331 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811191588 | NPI | - | NPPES |
| 0498049000 | Other | PA | KEYSTONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Michael Lieb |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1770641581 PECOS PAC ID: 8123151594 Enrollment ID: I20100805000434 |
| Provider Name | Maya Spodik |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1356559850 PECOS PAC ID: 7214060466 Enrollment ID: I20100809000607 |
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