Healthcare Provider Details

I. General information

NPI: 1659359529
Provider Name (Legal Business Name): MARTIN NICHOLAS LESNAK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 UNIVERSITY DR EAST SUITE A
HURON OH
44839
US

IV. Provider business mailing address

2320 UNIVERSITY DR EAST
HURON OH
44839-9173
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-4800
  • Fax: 419-433-4833
Mailing address:
  • Phone: 419-433-4800
  • Fax: 419-433-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number3390
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3390
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: