Provider Demographics
NPI:1750332854
Name:LESSIE, TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:LESSIE
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 1:2492 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-9552
Mailing Address - Country:US
Mailing Address - Phone:520-722-8994
Mailing Address - Fax:520-624-0117
Practice Address - Street 1:2492 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-9552
Practice Address - Country:US
Practice Address - Phone:520-722-8994
Practice Address - Fax:520-624-0117
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ291772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ561284Medicaid
AZ65517Medicare PIN
H12920Medicare UPIN