Provider Demographics
NPI:1194818245
Name:LEBOVIC, DAN ISRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ISRAEL
Last Name:LEBOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-2400
Mailing Address - Fax:314-286-2455
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:DIV OB REPRODUCTIVE ENDOCRINOLOGY, STE 3100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-2400
Practice Address - Fax:314-286-2455
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030496207VE0102X
MN60270207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200112952Medicaid