Healthcare Provider Details

I. General information

NPI: 1316868516
Provider Name (Legal Business Name): EVAN LESKIW
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 STATE ROUTE 44
ROOTSTOWN OH
44272-9698
US

IV. Provider business mailing address

3777 CASCADES BLVD APT 207
KENT OH
44240-8041
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-3202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: