MEDICARE: DR. LESLIE ANDREW LENERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G060812	CA

General Provider Information

NPI Number	:	1053492413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ANDREW LENERT M.D.

Provider Business Mailing Address
First Line	:	30 N 1900 E
Second Line	:	ROOM 4C104
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2406
Country	:	US
Telephone Number	:	801-581-7906
Fax Number	:	801-581-5393

Provider Business Practice Location Address
First Line	:	30 N 1900 E
Second Line	:	ROOM 4C104
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2406
Country	:	US
Telephone Number	:	801-581-7906
Fax Number	:	801-581-5393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	09/19/2012

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