Basic Information
| Provider Information | |||||||||
| NPI: | 1992759336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMPERT | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 E BELLEVIEW AVE | ||||||||
| Address2: | NO 124 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 41158 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25222 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-36556 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17553 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200426300A | 05 | OK | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 104686249 | 05 | MI | MEDICAID | 1992759336 | 05 | MT | MEDICAID | 009981075 | 05 | AL | MEDICAID | 1992759336 | 05 | WY | MEDICAID | 300138104 | 01 | CO | RR MIC MEDICARE | OTHER | 300138105 | 01 | CO | RR RIA MEDICARE | OTHER | 200417140A | 05 | KS | MEDICAID | 927212 | 05 | AZ | MEDICAID | 3106056 | 05 | TX | MEDICAID | 1992759336 | 05 | CA | MEDICAID | 1992759336 | 05 | IA | MEDICAID | 1992759336 | 05 | CT | MEDICAID | 0066348 | 05 | OH | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 86355261 | 05 | CO | MEDICAID | 7617653 | 05 | NC | MEDICAID | CO305743 | 01 | NE | MEDICARE TRAILBLAZER RIN | OTHER |