MEDICARE: IRENE H LESNIAK MD

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	207Q00000X	Family Medicine Physician	A46607	CA
2	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31603819	OTHER		BCBS

General Provider Information

NPI Number	:	1366526857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE H LESNIAK MD

Provider Business Mailing Address
First Line	:	6415 W ARCHER
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	773-788-1702
Fax Number	:	773-788-1709

Provider Business Practice Location Address
First Line	:	6415 W ARCHER
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	773-788-1702
Fax Number	:	773-788-1709

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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Directions to “ IRENE H LESNIAK MD” Practice Location

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