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NPI Code Detail

MEDICARE: LESLEY ELLEN BRINKMAN-MOSIMAN M. D.

MEDICARE: LESLEY ELLEN BRINKMAN-MOSIMAN M. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician036-076129IL
2207V00000XObstetrics & Gynecology PhysicianME141553FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2LM689OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
39032006OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1649340019
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLEY ELLEN BRINKMAN-MOSIMAN M. D.
Provider Business Mailing Address
First Line : PO BOX 748817
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8817
Country : US
Telephone Number : 813-286-0333
Fax Number : 813-282-1806
Provider Business Practice Location Address
First Line : 4030 W BOY SCOUT BLVD STE 800
Second Line :
City : TAMPA
State : FL
Zip : 33607-5713
Country : US
Telephone Number : 813-286-0333
Fax Number : 813-282-1806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 06/22/2023

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Directions to “ LESLEY ELLEN BRINKMAN-MOSIMAN M. D.” Practice Location

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