Provider Demographics
NPI:1982707857
Name:LEBEAU, DAVID P (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:LEBEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3038
Mailing Address - Country:US
Mailing Address - Phone:618-398-8840
Mailing Address - Fax:618-398-8847
Practice Address - Street 1:7210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3038
Practice Address - Country:US
Practice Address - Phone:618-398-8840
Practice Address - Fax:618-398-8847
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102560Medicaid
ILH18899Medicare UPIN
ILL82079Medicare ID - Type Unspecified