Healthcare Provider Details

I. General information

NPI: 1023380797
Provider Name (Legal Business Name): LEONARD SAMUEL GELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 CONSERVATION ST NE
ADA MI
49301-9522
US

IV. Provider business mailing address

970 PARCHMENT DR SE
GRAND RAPIDS MI
49546-8302
US

V. Phone/Fax

Practice location:
  • Phone: 616-676-9438
  • Fax:
Mailing address:
  • Phone: 616-676-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberL1647957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: