MEDICARE: MARTIN JAMES LEONARD RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	4704136900	MI

General Provider Information

NPI Number	:	1194347211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN JAMES LEONARD RN

Provider Business Mailing Address
First Line	:	PO BOX 1866
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-5666
Country	:	US
Telephone Number	:	248-472-9698
Fax Number	:	248-587-8698

Provider Business Practice Location Address
First Line	:	3067 BEACH LAKE DR E
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-2864
Country	:	US
Telephone Number	:	248-684-6013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

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