Provider Demographics
NPI:1942368915
Name:SLAZINSKI, LEONARD (M D)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:SLAZINSKI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3841
Mailing Address - Country:US
Mailing Address - Phone:941-365-5582
Mailing Address - Fax:941-365-5581
Practice Address - Street 1:2426 S TAMIAMI TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3841
Practice Address - Country:US
Practice Address - Phone:941-365-5582
Practice Address - Fax:941-365-5581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030860207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067190800Medicaid
FLD54989Medicare UPIN
FL067190800Medicaid