MEDICARE: MARK LESHIN MD

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
1	208D00000X	General Practice Physician	E9768	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00DP97	OTHER	TX	MEDICARE ID

General Provider Information

NPI Number	:	1871592485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LESHIN MD

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	STE #1160
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-828-1276
Fax Number	:	214-828-0213

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	#1160
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-828-1276
Fax Number	:	214-828-0213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	03/22/2013

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Directions to “ MARK LESHIN MD” Practice Location

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