Provider Demographics
NPI:1760430029
Name:LESCHAK, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:LESCHAK
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 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:800-991-6117
Mailing Address - Fax:
Practice Address - Street 1:2290 10TH AVE N STE 101
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6609
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS269152085R0204X
TN539802085R0204X
ALMD445992085R0204X
FLME144270202K00000X, 2085R0204X
ARE-174942085R0204X
AZ595862085R0204X
PAMD055735L2085R0204X
TXS18502085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021429Medicaid
TNQ021429Medicaid
PAG89422Medicare UPIN
PA30026850OtherKEYSTONE MERCY
PA0815057000OtherAMERIHEALTH/INTERCOUNTY
PA5489636OtherAETNA PPO
PA1172543OtherAETNA HMO
PA4168624OtherCIGNA HMO/PPO
PA789595T92Medicare ID - Type Unspecified
PA0016022810006Medicaid
PA789595OtherHIGHMARK BLUE SHIELD