Provider Demographics
NPI:1154322477
Name:LESCAY, HERNAN LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:LUIS
Last Name:LESCAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN STREET NE MC 845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2558 HENRY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3024
Practice Address - Country:US
Practice Address - Phone:231-291-8150
Practice Address - Fax:231-291-8155
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4728358Medicaid
MI4954368Medicaid
MIN28430073Medicare PIN
MII30193Medicare UPIN