Provider Demographics
NPI:1457357485
Name:MICHAEL RICHARD LEBENS, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL RICHARD LEBENS, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LEBENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-434-0770
Mailing Address - Street 1:265 POSADA LN
Mailing Address - Street 2:STE D
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4056
Mailing Address - Country:US
Mailing Address - Phone:805-434-0770
Mailing Address - Fax:805-434-5124
Practice Address - Street 1:265 POSADA LN
Practice Address - Street 2:STE D
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4056
Practice Address - Country:US
Practice Address - Phone:805-434-0770
Practice Address - Fax:805-434-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47952Medicare UPIN
CAW21566Medicare PIN