Healthcare Provider Details

I. General information

NPI: 1982645255
Provider Name (Legal Business Name): LESTER J MASCOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 TELEGRAPH RD
REDFORD MI
48239
US

IV. Provider business mailing address

1800 W BIG BEAVER SUITE 150
TROY MI
48084
US

V. Phone/Fax

Practice location:
  • Phone: 313-534-0300
  • Fax: 315-534-6408
Mailing address:
  • Phone: 248-649-2323
  • Fax: 248-649-5998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberLM049243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: