Provider Demographics
NPI:1194794321
Name:LIABOE, MARK O (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:O
Last Name:LIABOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1515 DELHI ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6320
Mailing Address - Country:US
Mailing Address - Phone:563-557-9111
Mailing Address - Fax:563-589-4046
Practice Address - Street 1:1515 DELHI ST
Practice Address - Street 2:STE 100
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6320
Practice Address - Country:US
Practice Address - Phone:563-557-9111
Practice Address - Fax:563-589-4046
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA22876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0194662Medicaid
WI30449800Medicaid
IL0180379097Medicaid
WI30449800Medicaid
19466Medicare PIN