Healthcare Provider Details

I. General information

NPI: 1538716469
Provider Name (Legal Business Name): MICHAEL ALAN LEBLANC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

15285 DICKERSON DR
FENTON MI
48430-1601
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3705
  • Fax:
Mailing address:
  • Phone: 734-649-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851112889
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: