MEDICARE: JAMES LEBAMOFF MD

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	01036569	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	930106017	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000191935	OTHER	IN	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932185279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LEBAMOFF MD

Provider Business Mailing Address
First Line	:	608 UNION CHAPEL RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9357
Country	:	US
Telephone Number	:	260-428-4440
Fax Number	:	260-482-4442

Provider Business Practice Location Address
First Line	:	10 JOHN KISSINGER DR
Second Line	:
City	:	WABASH
State	:	IN
Zip	:	46992-1648
Country	:	US
Telephone Number	:	260-563-3131
Fax Number	:	260-482-4442

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	04/21/2024

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