Provider Demographics
NPI:1639550759
Name:LESAR, JONATHAN (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LESAR
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 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1116
Mailing Address - Country:US
Mailing Address - Phone:765-932-7061
Mailing Address - Fax:765-932-7062
Practice Address - Street 1:110 E. 13TH STREET
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1116
Practice Address - Country:US
Practice Address - Phone:765-932-7063
Practice Address - Fax:765-932-7576
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN07001278A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty