Provider Demographics
NPI:1538124904
Name:TENGSICO, LESTER F (DPM)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:F
Last Name:TENGSICO
Suffix:
Gender:M
Credentials:DPM
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 33912
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-3912
Mailing Address - Country:US
Mailing Address - Phone:503-760-5151
Mailing Address - Fax:503-972-2195
Practice Address - Street 1:7505SEPOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2453
Practice Address - Country:US
Practice Address - Phone:503-760-5151
Practice Address - Fax:503-972-2195
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00263213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDS076893Medicaid
ORR0000SGBMPMedicare ID - Type Unspecified
U55898Medicare UPIN