Provider Demographics
NPI:1467528455
Name:JASZCZAK, LESZEK J (MD)
Entity Type:Individual
Prefix:DR
First Name:LESZEK
Middle Name:J
Last Name:JASZCZAK
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:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-1148
Mailing Address - Country:US
Mailing Address - Phone:701-577-6337
Mailing Address - Fax:
Practice Address - Street 1:3 4TH ST E
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5350
Practice Address - Country:US
Practice Address - Phone:701-577-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND77822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10182Medicaid
ND15191Medicare ID - Type Unspecified
ND10182Medicaid