Provider Demographics
NPI:1508829433
Name:LEBREDO, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:LEBREDO
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 1:2730 PIERCE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3796
Mailing Address - Country:US
Mailing Address - Phone:712-234-8725
Mailing Address - Fax:712-234-8728
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-234-8725
Practice Address - Fax:712-234-8728
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28161208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025458000Medicaid
IAP00388040OtherMEDICARE RAILROAD
SD7798853Medicaid
IA2072538Medicaid
IA28659OtherWELLMARK BCBS IOWA
NE10025458000Medicaid