Healthcare Provider Details

I. General information

NPI: 1609011337
Provider Name (Legal Business Name): LOUIS MIKE LESSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 VICENTE RD
BERKELEY CA
94705-1605
US

IV. Provider business mailing address

181 VICENTE RD
BERKELEY CA
94705-1605
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-0700
  • Fax: 510-848-0422
Mailing address:
  • Phone: 510-845-0700
  • Fax: 510-848-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG15468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: