Provider Demographics
NPI:1659359529
Name:LESNAK, MARTIN NICHOLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:NICHOLAS
Last Name:LESNAK
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 1:2320 UNIVERSITY DR EAST
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-9173
Mailing Address - Country:US
Mailing Address - Phone:419-433-4800
Mailing Address - Fax:419-433-4833
Practice Address - Street 1:2320 UNIVERSITY DR EAST
Practice Address - Street 2:SUITE A
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839
Practice Address - Country:US
Practice Address - Phone:419-433-4800
Practice Address - Fax:419-433-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3390213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2519706Medicaid
U95708Medicare UPIN
OH2519706Medicaid
OH4147171Medicare ID - Type Unspecified