Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12010935A | IN |
NPI | 1093849424 |
---|---|
Provider Name | Dr. Lisa Marie Leniski |
First Address | Michigan City, IN 46360-3364 |
Second Address | Michigan City, IN 46360-3364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201036320 | (05) | IN |