Provider Demographics
NPI:1528007317
Name:SCHOLL, LESLEY M (MD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:M
Last Name:SCHOLL
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 1:822 S 500 W
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8377
Mailing Address - Country:US
Mailing Address - Phone:260-726-9027
Mailing Address - Fax:
Practice Address - Street 1:822 S 500 W
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-8377
Practice Address - Country:US
Practice Address - Phone:260-726-9027
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037897A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE11163Medicare UPIN
IN142930KKMedicare ID - Type UnspecifiedMEDICARE