Provider Demographics
NPI:1912979451
Name:LESNIAK, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:LESNIAK
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 1:1500 WALNUT RIDGE DR
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9317
Mailing Address - Country:US
Mailing Address - Phone:262-928-7500
Mailing Address - Fax:
Practice Address - Street 1:1500 WALNUT RIDGE DR
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9317
Practice Address - Country:US
Practice Address - Phone:262-928-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32480400Medicaid
WI000368275Medicare PIN
WIG78401Medicare UPIN
WI683750633Medicare PIN