Healthcare Provider Details

I. General information

NPI: 1467560342
Provider Name (Legal Business Name): PETER EDWARD LESINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

5726 LAKESHORE RD
FORT GRATIOT MI
48059-2815
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-7829
  • Fax: 810-987-2336
Mailing address:
  • Phone: 810-385-4293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: