Healthcare Provider Details

I. General information

NPI: 1174796973
Provider Name (Legal Business Name): DUSAN LEKIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

579 NW LAKE WHITNEY PL SUITE 103
PORT SAINT LUCIE FL
34986-1622
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-7180
  • Fax: 559-600-7708
Mailing address:
  • Phone: 772-249-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA108722
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number234342
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: