Healthcare Provider Details

I. General information

NPI: 1285100529
Provider Name (Legal Business Name): LAUREN E LESNIEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1210
CHICAGO IL
60611-4490
US

IV. Provider business mailing address

676 N LASALLE DR APT 708
CHICAGO IL
60654
US

V. Phone/Fax

Practice location:
  • Phone: 312-587-3765
  • Fax:
Mailing address:
  • Phone: 585-545-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004637
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOA004637
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: