Healthcare Provider Details

I. General information

NPI: 1760746903
Provider Name (Legal Business Name): LESLIE M LEMANEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S LINCOLN RD STE 100
ESCANABA MI
49829-1293
US

IV. Provider business mailing address

710 S LINCOLN RD STE 100
ESCANABA MI
49829-1293
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-4628
  • Fax:
Mailing address:
  • Phone: 906-786-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301114654
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: