Provider Demographics
NPI:1992763668
Name:LEIBOWICH, SHLOMO (MD)
Entity type:Individual
Prefix:
First Name:SHLOMO
Middle Name:
Last Name:LEIBOWICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2520
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:296-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC546792085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54957600Medicaid
CAGW836BMedicare PIN
FL12607Medicare ID - Type Unspecified
CAGW836FMedicare PIN
CAGW836XMedicare PIN
CAGW836LMedicare PIN
CAGW836DMedicare PIN
CAGW836HMedicare PIN
CAGW836JMedicare PIN
CAGW836UMedicare PIN
CAGW836IMedicare PIN
CAGW836MMedicare PIN
CAGW836VMedicare PIN
CAGW836AMedicare PIN
CAGW836QMedicare PIN
E45073Medicare UPIN
FL54957600Medicaid
CAGW836GMedicare PIN
CAGW836OMedicare PIN
CAGW836RMedicare PIN
CAGW836TMedicare PIN
CAGW836WMedicare PIN
CAGW836KMedicare PIN
CAGW836EMedicare PIN
CAGW836NMedicare PIN
CAGW836PMedicare PIN
CAGW836CMedicare PIN