Provider Demographics
NPI:1265479554
Name:LESSARD, LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:LESSARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 W HOLT RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1666
Mailing Address - Country:US
Mailing Address - Phone:517-694-1466
Mailing Address - Fax:517-694-3530
Practice Address - Street 1:4738 W HOLT RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1666
Practice Address - Country:US
Practice Address - Phone:517-694-1466
Practice Address - Fax:517-694-3530
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILL007973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LL007973OtherBCBSM
MI0170133Medicaid
MI114346407Medicaid
LL007973OtherBCN BLUE CARE NETWORK
MI0101075OtherPHYSICIANS HEALTH PLAN OF
LL007973OtherBCN BLUE CARE NETWORK
C36477006Medicare ID - Type Unspecified
MI114346407Medicaid