Provider Demographics
NPI:1124016233
Name:LOMBARDO, MICHAEL L (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PECAN PARK AVE # A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3308
Mailing Address - Country:US
Mailing Address - Phone:318-445-9259
Mailing Address - Fax:318-445-9921
Practice Address - Street 1:212 PECAN PARK AVE # A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3308
Practice Address - Country:US
Practice Address - Phone:318-445-9259
Practice Address - Fax:318-445-9921
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD107R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1904929Medicaid
LA56576Medicare PIN
LA1904929Medicaid