Healthcare Provider Details

I. General information

NPI: 1306429790
Provider Name (Legal Business Name): AARON JOSEPH LEACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 N EVERGREEN DR. NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

1840 WEALTHY ST SE STE 2C-250
GRAND RAPIDS MI
49506-2921
US

V. Phone/Fax

Practice location:
  • Phone: 722-561-6459
  • Fax:
Mailing address:
  • Phone: 616-774-0101
  • Fax: 616-267-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4351048045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: