Provider Demographics
NPI:1790839041
Name:PURETZ, LESTER M (DO)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:M
Last Name:PURETZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HARNESS WAY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8502
Mailing Address - Country:US
Mailing Address - Phone:517-230-7551
Mailing Address - Fax:
Practice Address - Street 1:425 HARNESS WAY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8502
Practice Address - Country:US
Practice Address - Phone:517-230-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0044486208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336541Medicaid
MI38-2168683OtherTAX ID
MI38-2168683OtherTAX ID
MIB47672Medicare UPIN