Healthcare Provider Details

I. General information

NPI: 1902735764
Provider Name (Legal Business Name): LEO EPPINGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALI EPPINGA

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RENAISSANCE CTR STE 2600
DETROIT MI
48243-1599
US

IV. Provider business mailing address

910 SEWARD ST RM 408
DETROIT MI
48202-2355
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: