Healthcare Provider Details

I. General information

NPI: 1932140738
Provider Name (Legal Business Name): LEENA JINDAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PL
FLINT MI
48503-2465
US

IV. Provider business mailing address

806 TUURI PL
FLINT MI
48503-2465
US

V. Phone/Fax

Practice location:
  • Phone: 810-237-7572
  • Fax: 810-237-7567
Mailing address:
  • Phone: 810-237-7572
  • Fax: 810-237-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101014383
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: