MEDICARE: MICHAEL RICHARD LEBENS, MD A PROFESSIONAL CORPORATION

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	207Q00000X	Family Medicine Physician	A70273	CA

General Provider Information

NPI Number	:	1457357485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL RICHARD LEBENS, MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	265 POSADA LN
Second Line	:	STE D
City	:	TEMPLETON
State	:	CA
Zip	:	93465-4056
Country	:	US
Telephone Number	:	805-434-0770
Fax Number	:	805-434-5124

Provider Business Practice Location Address
First Line	:	265 POSADA LN
Second Line	:	STE D
City	:	TEMPLETON
State	:	CA
Zip	:	93465-4056
Country	:	US
Telephone Number	:	805-434-0770
Fax Number	:	805-434-5124

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL RICHARD LEBENS
Credential	:	M.D.
Telephone Number	:	805-434-0770

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/13/2020

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