Healthcare Provider Details

I. General information

NPI: 1619972122
Provider Name (Legal Business Name): ERIC P LESTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LESTER AVE STE 119
SAINT JOSEPH MI
49085-2565
US

IV. Provider business mailing address

3380 LINCOLN AVE
SAINT JOSEPH MI
49085-3703
US

V. Phone/Fax

Practice location:
  • Phone: 269-385-0029
  • Fax: 269-985-0040
Mailing address:
  • Phone: 269-985-0029
  • Fax: 269-985-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301058814
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: