Provider Demographics
NPI:1972698835
Name:PLAWNY-LEBENBOM, KLAUDIA (MD)
Entity Type:Individual
Prefix:
First Name:KLAUDIA
Middle Name:
Last Name:PLAWNY-LEBENBOM
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 1:2689 SOLUTION CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:586-329-1880
Mailing Address - Fax:586-231-0055
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:# 300
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-726-5566
Practice Address - Fax:586-726-8085
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI41544410Medicaid
MI0Q2646630007Medicare PIN
MI41544410Medicaid