Provider Demographics
NPI:1811149644
Name:THOMAS A LEBEAU DPM PC
Entity type:Organization
Organization Name:THOMAS A LEBEAU DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-974-1979
Mailing Address - Street 1:957 NOVI RD
Mailing Address - Street 2:APT 16
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1169
Mailing Address - Country:US
Mailing Address - Phone:248-974-1979
Mailing Address - Fax:
Practice Address - Street 1:957 NOVI RD
Practice Address - Street 2:APT 16
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1169
Practice Address - Country:US
Practice Address - Phone:248-974-1979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001508213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty