Healthcare Provider Details

I. General information

NPI: 1588967137
Provider Name (Legal Business Name): MARION PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 8TH AVENUE SE
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

PO BOX 11593
CEDAR RAPIDS IA
52410-1593
US

V. Phone/Fax

Practice location:
  • Phone: 319-373-7563
  • Fax:
Mailing address:
  • Phone: 319-373-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36305
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOSEPH JAMES LESNIK
Title or Position: PRESIDENT AND SECRETARY
Credential: M.D.
Phone: 319-373-7563