Provider Demographics
NPI:1982850608
Name:PAUL R. LESSEM, MD, PC
Entity Type:Organization
Organization Name:PAUL R. LESSEM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LESSEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-547-6733
Mailing Address - Street 1:26789 WOODWARD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1335
Mailing Address - Country:US
Mailing Address - Phone:248-547-6733
Mailing Address - Fax:
Practice Address - Street 1:26789 WOODWARD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1335
Practice Address - Country:US
Practice Address - Phone:248-547-6733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1422425-10Medicaid
2606363462OtherBLUE CROSS
MI06363460261Medicaid
MI06363460261Medicaid
2606363462OtherBLUE CROSS