Provider Demographics
NPI:1801884853
Name:LEIBOWITZ, STACEY B (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:B
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 SW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6250
Mailing Address - Country:US
Mailing Address - Phone:305-661-6280
Mailing Address - Fax:
Practice Address - Street 1:7730 SW 47TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-6250
Practice Address - Country:US
Practice Address - Phone:305-661-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114813207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032565Medicaid
NJ077087BL0Medicare ID - Type Unspecified
NJ0032565Medicaid