MEDICARE: KENT LEMBURG M.T.

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	174400000X	Specialist	1849	CO

General Provider Information

NPI Number	:	1629204821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT LEMBURG M.T.

Provider Business Mailing Address
First Line	:	3470 S SHERMAN ST
Second Line	:	SUITE 3
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2663
Country	:	US
Telephone Number	:	303-628-0205
Fax Number	:	303-789-5215

Provider Business Practice Location Address
First Line	:	3470 S SHERMAN ST
Second Line	:	SUITE 3
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2680
Country	:	US
Telephone Number	:	303-628-0205
Fax Number	:	303-789-5215

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	03/23/2012

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