Provider Demographics
NPI:1629204821
Name:LEMBURG, KENT (MT)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:LEMBURG
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 S SHERMAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2663
Mailing Address - Country:US
Mailing Address - Phone:303-628-0205
Mailing Address - Fax:303-789-5215
Practice Address - Street 1:3470 S SHERMAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2680
Practice Address - Country:US
Practice Address - Phone:303-628-0205
Practice Address - Fax:303-789-5215
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1849174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist