Provider Demographics
NPI:1174697783
Name:LEKANDER, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LEKANDER
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 1:1375 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3382
Mailing Address - Country:US
Mailing Address - Phone:707-431-6530
Mailing Address - Fax:
Practice Address - Street 1:1375 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3382
Practice Address - Country:US
Practice Address - Phone:707-431-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85799207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G857990Medicaid
00G857990Medicare ID - Type Unspecified
H14016Medicare UPIN