Provider Demographics
NPI:1871551507
Name:LEBAMOFF, STEPHAN (MD)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:LEBAMOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56-117 PUALALEA ST
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2052
Mailing Address - Country:US
Mailing Address - Phone:808-293-9221
Mailing Address - Fax:808-293-6290
Practice Address - Street 1:56-117 PUALALEA ST
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2052
Practice Address - Country:US
Practice Address - Phone:808-293-9221
Practice Address - Fax:808-293-6290
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102137Medicare PIN
HIH102140Medicare PIN
HIH102139Medicare PIN
HID94455Medicare UPIN
HIH102138Medicare PIN