Provider Demographics
NPI:1619972122
Name:LESTER, ERIC P (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:LESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3380 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3703
Mailing Address - Country:US
Mailing Address - Phone:269-985-0029
Mailing Address - Fax:269-985-0040
Practice Address - Street 1:820 LESTER AVE
Practice Address - Street 2:STE 119
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2565
Practice Address - Country:US
Practice Address - Phone:269-385-0029
Practice Address - Fax:269-985-0040
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058814207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI36-31227OtherPHYSICIANS HEALTH PLAN
MI38-3512985OtherTAX I.D.
MI11-0110079-1OtherBCBS
MI4177117Medicaid
MI11-0110079-1OtherBCBS
MIA97689Medicare UPIN