Provider Demographics
NPI:1639112147
Name:LESNIK, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:LESNIK
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 1:74090 EL PASEO
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4135
Mailing Address - Country:US
Mailing Address - Phone:760-341-8244
Mailing Address - Fax:760-776-1474
Practice Address - Street 1:74090 EL PASEO
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4135
Practice Address - Country:US
Practice Address - Phone:760-341-8244
Practice Address - Fax:760-776-1474
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG064878207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG064878OtherSTATE MEDICAL LICENSE
00G648782Medicare ID - Type Unspecified
00G648781Medicare ID - Type Unspecified
00G648780Medicare ID - Type Unspecified
CAG064878OtherSTATE MEDICAL LICENSE