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ERIC J LEESTMA

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1700989233

Individual Registrant:
 ERIC J LEESTMA 
Gender: M
Sole Proprietor

Location and contact information for practice:
519 N HALLECK  DEMOTTE, IN 46310 US
Tel: 219-987-7750  Fax: 219-987-5750

Contact information for business:
PO BOX 850  DEMOTTE, IN 46310-0850 US
Tel: 219-987-7750  Fax: 219-987-5750

Registration Information:
NPI: 1700989233
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
IN02000641A

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
ANTHEM BCBS000000084931IN01
100209310AIN05
INDIANA HEALTH NETWORK36655IN01




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