Healthcare Provider Details

I. General information

NPI: 1285646729
Provider Name (Legal Business Name): ZACHARY JOE MARANAR LESHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD STE 208
MISHAWAKA IN
46545-1464
US

IV. Provider business mailing address

707 CEDAR ST STE 405
SOUTH BEND IN
46617-2059
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-6700
  • Fax: 574-335-0726
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberML20008451
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301092796
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01072811A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01072811A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: