Provider Demographics
NPI:1043248792
Name:LALIBERTE, CLIFFORD (DPM)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:
Last Name:LALIBERTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:248-922-3338
Mailing Address - Fax:248-922-9617
Practice Address - Street 1:5653 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3149
Practice Address - Country:US
Practice Address - Phone:248-922-3338
Practice Address - Fax:248-922-9617
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001147213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1096390002Medicare NSC
MIU33250Medicare UPIN
MI0B54895Medicare PIN