MEDICARE: MR. IAN-MICHAEL ANTHONY LENTE PA-C

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	363AM0700X	Medical Physician Assistant	NM 84PA010	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	990283	OTHER	NM	UNMH PROVIDER NUMBER

General Provider Information

NPI Number	:	1447231261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IAN-MICHAEL ANTHONY LENTE PA-C

Provider Business Mailing Address
First Line	:	512 ASH ST. S.E.
Second Line	:	APT. #1-B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106
Country	:	US
Telephone Number	:	505-977-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 BRIDGE BLVD SW
Second Line	:	SUITE B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-3765
Country	:	US
Telephone Number	:	505-508-1739
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/05/2012

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