Provider Demographics
NPI:1417184474
Name:MICHAEL LESEM, MD, PA
Entity Type:Organization
Organization Name:MICHAEL LESEM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LESEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-538-1479
Mailing Address - Street 1:4306 YOAKUM BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5873
Mailing Address - Country:US
Mailing Address - Phone:832-538-1479
Mailing Address - Fax:832-487-9566
Practice Address - Street 1:4306 YOAKUM BLVD STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5873
Practice Address - Country:US
Practice Address - Phone:832-538-1479
Practice Address - Fax:832-487-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24353Medicare UPIN
TX00F97LMedicare PIN