Basic Information
| Provider Information | |||||||||
| NPI: | 1295777563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESKOSKY | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 036-122191 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 34939 | KY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 24939 | 01 | KY | KY MEDICAL LICENSE | OTHER | P01002604 | 01 | RAILROAD MEDICARE | OTHER | 64439391 | 05 | KY | MEDICAID | 000000574645 | 01 | KY | ANTHEM BCBS | OTHER |