Healthcare Provider Details

I. General information

NPI: 1346242732
Provider Name (Legal Business Name): JOHN L LEHTINEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 35
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE STE 242
MARQUETTE MI
49855-5406
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4555
  • Fax: 906-225-4554
Mailing address:
  • Phone: 906-449-4900
  • Fax: 906-449-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301035115
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301035115
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: