Provider Demographics
NPI:1104868660
Name:LEBOW, MAX FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:FRANKLIN
Last Name:LEBOW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1140 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4906
Mailing Address - Country:US
Mailing Address - Phone:310-546-5049
Mailing Address - Fax:310-546-1641
Practice Address - Street 1:9601 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5203
Practice Address - Country:US
Practice Address - Phone:310-419-7058
Practice Address - Fax:310-491-7075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2011-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG49950207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G499500Medicaid
CAA51517Medicare UPIN
CA00G499500Medicaid