Provider Demographics
NPI:1356395107
Name:LEBOW, ROBERT F (MD,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:LEBOW
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 1:907 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3625
Mailing Address - Country:US
Mailing Address - Phone:317-262-0950
Mailing Address - Fax:317-267-0244
Practice Address - Street 1:907 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3625
Practice Address - Country:US
Practice Address - Phone:317-262-0950
Practice Address - Fax:317-267-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026950A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087200OtherANTHEM BLUE CROSS BLUE SH
IN100226720Medicaid
IN000000087200OtherANTHEM BLUE CROSS BLUE SH
IN100226720Medicaid