MEDICARE: DR. LAURA M LEBEAU D.P.M.

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	213E00000X	Podiatrist	016004478	IL
2	213E00000X	Podiatrist	835025	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	60000161	OTHER	BLUE CROSS BLUE SHIELD
3	0732240001	OTHER	DEMERC # WITH PPG

General Provider Information

NPI Number	:	1962454017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA M LEBEAU D.P.M.

Provider Business Mailing Address
First Line	:	2124 S AUSTIN BLVD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2012
Country	:	US
Telephone Number	:	708-863-5376
Fax Number	:	708-863-5375

Provider Business Practice Location Address
First Line	:	2124 S AUSTIN BLVD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2012
Country	:	US
Telephone Number	:	708-863-5376
Fax Number	:	708-863-5375

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/23/2014

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