MEDICARE: DR. MAX FRANKLIN LEBOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G49950	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104868660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAX FRANKLIN LEBOW M.D.

Provider Business Mailing Address
First Line	:	1140 LAUREL AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-4906
Country	:	US
Telephone Number	:	310-546-5049
Fax Number	:	310-546-1641

Provider Business Practice Location Address
First Line	:	9601 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5203
Country	:	US
Telephone Number	:	310-419-7058
Fax Number	:	310-491-7075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/28/2011

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