Provider Demographics
NPI:1588667034
Name:LESIAK, LAURENCE FRANK (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:FRANK
Last Name:LESIAK
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 1:620 N DIERS AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4984
Mailing Address - Country:US
Mailing Address - Phone:308-384-5400
Mailing Address - Fax:308-384-5201
Practice Address - Street 1:620 N DIERS AVE
Practice Address - Street 2:STE 200
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4984
Practice Address - Country:US
Practice Address - Phone:308-384-5400
Practice Address - Fax:308-384-5201
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4B91207X00000X
NE15386207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3959OtherBC/BS
NE47054564512Medicaid
NE3959OtherBC/BS
NE47054564512Medicaid