Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000409 | WA |
N | 222Z00000X | Podiatrist | OI00000409 | WA |
Y | 224P00000X | Prosthetist | PS00000410 | WA |
N | 225000000X | Orthotic Fitter | PS00000410 | WA |
NPI | 1316250319 |
---|---|
Provider Name | Igor Lesko |
First Address | Tracy, CA 95304-9314 |
Second Address | Seattle, WA 98122-5698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 10/01/2012 |