Healthcare Provider Details

I. General information

NPI: 1548382849
Provider Name (Legal Business Name): LEO MILTON PARSONS II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R STREET, 5 HUDSON
DETROIT MI
48201
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST RM 9C
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-7105
  • Fax: 313-993-0302
Mailing address:
  • Phone: 586-747-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number5101016877
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016877
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: