Healthcare Provider Details

I. General information

NPI: 1225728769
Provider Name (Legal Business Name): LEIGHANN NICHOLE LESLIE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

IV. Provider business mailing address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-0139
  • Fax: 313-745-5237
Mailing address:
  • Phone: 313-993-0139
  • Fax: 313-745-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number5101029382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: