Provider Demographics
NPI:1912059106
Name:LOENDORF, ALAN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:LOENDORF
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-0607
Mailing Address - Country:US
Mailing Address - Phone:406-232-3456
Mailing Address - Fax:406-232-3538
Practice Address - Street 1:2000 CLARK ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301
Practice Address - Country:US
Practice Address - Phone:406-232-3456
Practice Address - Fax:406-232-3538
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT130213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000390201Medicaid
480022463OtherRR MEDICARE
MT0000390201Medicaid
480022463OtherRR MEDICARE