Provider Demographics
NPI:1588618086
Name:DESMUL, LEONARD B (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:B
Last Name:DESMUL
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 1:202 CONWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3112
Mailing Address - Country:US
Mailing Address - Phone:406-752-5656
Mailing Address - Fax:406-755-0971
Practice Address - Street 1:310 SUNNYVIEW LN
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-752-1708
Practice Address - Fax:406-755-0971
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10535207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT152694Medicaid
MT93136OtherBLUE CROSS
MT85249Medicare ID - Type Unspecified
MT93136OtherBLUE CROSS