Provider Demographics
NPI:1467590885
Name:KENNETH A LOMBARDI MD PLC
Entity Type:Organization
Organization Name:KENNETH A LOMBARDI MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-964-6262
Mailing Address - Street 1:391 S SHORE DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5446
Mailing Address - Country:US
Mailing Address - Phone:269-964-6262
Mailing Address - Fax:269-964-2456
Practice Address - Street 1:391 S SHORE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5446
Practice Address - Country:US
Practice Address - Phone:269-964-6262
Practice Address - Fax:269-964-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1101311831OtherBCBSM
MI0P54620Medicare PIN