Provider Demographics
NPI:1063488401
Name:LESSMANN, GARY P (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:LESSMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2970
Mailing Address - Country:US
Mailing Address - Phone:314-576-7357
Mailing Address - Fax:
Practice Address - Street 1:201 W MANOR DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2970
Practice Address - Country:US
Practice Address - Phone:314-576-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2C68207P00000X, 207Q00000X
IL036106713207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA26255Medicare UPIN
ILK45651Medicare PIN
ILIL1682004Medicare PIN