Provider Demographics
NPI:1386936086
Name:LAMBERTY, LEONARD KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:KENNETH
Last Name:LAMBERTY
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 1:22512 GREEN DAY DR
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-6306
Mailing Address - Country:US
Mailing Address - Phone:218-732-9289
Mailing Address - Fax:
Practice Address - Street 1:22 DAYTON AVE SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1526
Practice Address - Country:US
Practice Address - Phone:218-631-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23146207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine