Provider Demographics
NPI:1902433048
Name:LIEBAU, BRANDON GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:GREGORY
Last Name:LIEBAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6512 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7340
Mailing Address - Country:US
Mailing Address - Phone:330-499-5600
Mailing Address - Fax:330-499-4190
Practice Address - Street 1:6512 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7340
Practice Address - Country:US
Practice Address - Phone:330-499-5600
Practice Address - Fax:330-499-4190
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.146871208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics