Provider Demographics
NPI:1124042122
Name:SLEZAK, LORI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:SLEZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N HABANA AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7160
Mailing Address - Country:US
Mailing Address - Phone:813-879-8290
Mailing Address - Fax:813-873-1304
Practice Address - Street 1:4700 N HABANA AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7160
Practice Address - Country:US
Practice Address - Phone:813-879-8290
Practice Address - Fax:813-873-1304
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93310208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16238ZMedicare PIN