Provider Demographics
NPI:1770668048
Name:LEBEDEV, MICHAEL ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ABRAHAM
Last Name:LEBEDEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:202 HOWARD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3435
Mailing Address - Country:US
Mailing Address - Phone:863-967-6673
Mailing Address - Fax:863-551-9313
Practice Address - Street 1:202 HOWARD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3435
Practice Address - Country:US
Practice Address - Phone:863-967-6673
Practice Address - Fax:863-551-9313
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0050395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048443100Medicaid
FL05767Medicare ID - Type Unspecified
FL048443100Medicaid