Provider Demographics
NPI:1255361796
Name:LESTER, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:LESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5323
Mailing Address - Country:US
Mailing Address - Phone:931-537-6872
Mailing Address - Fax:931-537-6635
Practice Address - Street 1:660 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5323
Practice Address - Country:US
Practice Address - Phone:931-537-6872
Practice Address - Fax:931-537-6635
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24977207R00000X
TN13489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00360674OtherMEDICARE RAILROAD CARRIER
OK200088100AMedicaid
OK200088100AMedicaid
OKE37644Medicare UPIN