Healthcare Provider Details

I. General information

NPI: 1356395107
Provider Name (Legal Business Name): ROBERT F. LEBOW M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/22/2019
Certification Date: 12/22/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E MICHIGAN ST
INDIANAPOLIS IN
46202-3625
US

IV. Provider business mailing address

907 E MICHIGAN ST
INDIANAPOLIS IN
46202-3625
US

V. Phone/Fax

Practice location:
  • Phone: 317-262-0950
  • Fax: 317-267-0244
Mailing address:
  • Phone: 317-262-0950
  • Fax: 317-267-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01026950A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: