Provider Demographics
NPI:1063464253
Name:POLITTE, LENARD L (MD)
Entity Type:Individual
Prefix:
First Name:LENARD
Middle Name:L
Last Name:POLITTE
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2296
Practice Address - Fax:573-884-7743
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28468207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO060060778OtherRAILROAD MEDICARE
MOP00415670OtherRAILROAD MEDICARE
MO200716546Medicaid
MO043011870Medicare PIN
MO060060778OtherRAILROAD MEDICARE
MOP00415670OtherRAILROAD MEDICARE