Provider Demographics
NPI:1871321521
Name:LEBIODA, IZABELA
Entity type:Individual
Prefix:
First Name:IZABELA
Middle Name:
Last Name:LEBIODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49565 E VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1635
Mailing Address - Country:US
Mailing Address - Phone:586-457-7065
Mailing Address - Fax:
Practice Address - Street 1:49565 E VALLEY CIR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-1635
Practice Address - Country:US
Practice Address - Phone:586-457-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86326248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered