Provider Demographics
NPI:1003604489
Name:LEZAMA MORALES, JUANADRIAN BOSCO (MD)
Entity type:Individual
Prefix:
First Name:JUANADRIAN
Middle Name:BOSCO
Last Name:LEZAMA MORALES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3227
Mailing Address - Country:US
Mailing Address - Phone:414-424-5000
Mailing Address - Fax:
Practice Address - Street 1:1316 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3227
Practice Address - Country:US
Practice Address - Phone:414-424-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program