Provider Demographics
NPI:1689251704
Name:LESNIAK, CASEY (DO)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:LESNIAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:SIEFERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1205 HADLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1934
Practice Address - Country:US
Practice Address - Phone:317-824-9393
Practice Address - Fax:317-834-9399
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092104A207Q00000X
IN11021800A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine