Provider Demographics
NPI:1801081005
Name:BLINDER, LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:BLINDER
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 729
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MT
Mailing Address - Zip Code:59639-0729
Mailing Address - Country:US
Mailing Address - Phone:406-362-4603
Mailing Address - Fax:
Practice Address - Street 1:2363 MT HIGHWAY 200 W
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MT
Practice Address - Zip Code:59639-9561
Practice Address - Country:US
Practice Address - Phone:406-362-4603
Practice Address - Fax:406-362-4850
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT26593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1801081005Medicaid
MT1801081005Medicare PIN