Provider Demographics
NPI:1316945017
Name:LEBARON, TANIA M (MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:M
Last Name:LEBARON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8599
Mailing Address - Country:US
Mailing Address - Phone:231-775-2493
Mailing Address - Fax:231-775-2570
Practice Address - Street 1:8950 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8599
Practice Address - Country:US
Practice Address - Phone:231-775-2493
Practice Address - Fax:231-779-7701
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITL071995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA080H376070OtherGROUP BCBS
MI4307786Medicaid
MI130716OtherPREFERRED CHOICES
MA0808300572OtherINDIVIDUAL BCBS
MI130716OtherPREFERRED CHOICES
MIN27000005Medicare ID - Type Unspecified
MA080H376070OtherGROUP BCBS
MIH39734Medicare UPIN
MI4307786Medicaid