Basic Information
| Provider Information | |||||||||
| NPI: | 1053319954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIBER | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 S CEDAR ST | ||||||||
| Address2: | STE 116 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489104699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178872511 | ||||||||
| FaxNumber: | 5178824144 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W GREENLAWN AVE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174837550 | ||||||||
| FaxNumber: | 5178824144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 5101005979 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1816662 | 05 | MI | MEDICAID |