Provider Demographics
NPI:1871546416
Name:LESKOVAC, JOHN M (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:LESKOVAC
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4665 DOUGLAS CIR NW
Mailing Address - Street 2:STE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3673
Mailing Address - Country:US
Mailing Address - Phone:330-759-9350
Mailing Address - Fax:330-759-9387
Practice Address - Street 1:500 GYPSY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1315
Practice Address - Country:US
Practice Address - Phone:330-884-3679
Practice Address - Fax:330-884-3691
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN281961367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335913Medicaid
OHLE8230862Medicare ID - Type Unspecified