Provider Demographics
NPI:1760430029
Name:LESCHAK, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:LESCHAK
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 1:5683 S REX RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3821
Mailing Address - Country:US
Mailing Address - Phone:901-350-0678
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:5683 S REX RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3821
Practice Address - Country:US
Practice Address - Phone:901-350-0678
Practice Address - Fax:901-350-0677
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN539802085R0204X
PAMD055735L2085R0204X
ALMD445992085R0204X
AZ595862085R0204X
TXS18502085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021429Medicaid
TNQ021429Medicaid
PAG89422Medicare UPIN
PA30026850OtherKEYSTONE MERCY
PA0815057000OtherAMERIHEALTH/INTERCOUNTY
PA5489636OtherAETNA PPO
PA1172543OtherAETNA HMO
PA4168624OtherCIGNA HMO/PPO
PA789595T92Medicare ID - Type Unspecified
PA0016022810006Medicaid
PA789595OtherHIGHMARK BLUE SHIELD