MEDICARE: LESLEY A HARRIS 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	208000000X	Pediatrics Physician	40032	KY
2	207R00000X	Internal Medicine Physician	40032	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00388569	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000486608	OTHER	KY	ANTHEM FOR NCMA TYLER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	284510500	OTHER	KY	PAD NMCA TYLER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	50014893	OTHER	KY	PASSPORT NMCA TYLER

General Provider Information

NPI Number	:	1760407258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY A HARRIS MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-969-6552
Fax Number	:	502-212-1358

Provider Business Practice Location Address
First Line	:	12615 TAYLORSVILLE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-4452
Country	:	US
Telephone Number	:	502-261-1595
Fax Number	:	502-261-1590

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/24/2022

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Directions to “ LESLEY A HARRIS MD” Practice Location

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