Provider Demographics
NPI:1326229675
Name:LEONARD SLAZINSKI MD PA
Entity Type:Organization
Organization Name:LEONARD SLAZINSKI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-365-5582
Mailing Address - Street 1:2426 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3841
Mailing Address - Country:US
Mailing Address - Phone:941-365-5582
Mailing Address - Fax:941-365-5581
Practice Address - Street 1:2426 S TAMIAMI TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3841
Practice Address - Country:US
Practice Address - Phone:941-365-5582
Practice Address - Fax:941-365-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030860207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74755OtherBLUECROSSBLUESHIELD FL
FLK1657Medicare PIN