MEDICARE: PAUL ROBERT LESSEM 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	2084P0800X	Psychiatry Physician	4301030749	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4301030749	OTHER	MI	CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1467451161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ROBERT LESSEM MD

Provider Business Mailing Address
First Line	:	26789 WOODWARD AVE
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1335
Country	:	US
Telephone Number	:	248-547-6733
Fax Number	:

Provider Business Practice Location Address
First Line	:	26789 WOODWARD AVE
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1335
Country	:	US
Telephone Number	:	248-547-6733
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	03/07/2023

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