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General NPI Number Information
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NPI Number | 1215119599
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Entity Type | Organization
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Legal Business Name | RIVERSIDE ORTHOPEDIC CONSULTING
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 1240 BRIDGE STREET
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City | GRAFTON
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State | WI
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Zip | 53024
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Country | US
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Telephone | 262-375-4745
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467 1240 BRIDGE STREET
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City | GRAFTON
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State | WI
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Zip | 53024
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Country | US
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Telephone | 262-375-4745
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. JOHN F LESKO
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Credential | MD
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Telephone | 262-375-4745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 27262
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License Number State | WI
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