Provider Demographics
NPI:1972546299
Name:LESZKOWITZ, DAVID (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LESZKOWITZ
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 1:9178 HIGHLAND RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4619
Mailing Address - Country:US
Mailing Address - Phone:248-698-1999
Mailing Address - Fax:248-698-4446
Practice Address - Street 1:9178 HIGHLAND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4619
Practice Address - Country:US
Practice Address - Phone:248-698-1999
Practice Address - Fax:248-698-4446
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009614207Q00000X, 207QA0401X
FLOS17331207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI107475OtherCARE CHOICES HMO
MI5214041OtherAETNA INSURANCE
MI2738355Medicaid
MI0F37023002Medicare PIN
MIE49533Medicare UPIN