Healthcare Provider Details

I. General information

NPI: 1598179277
Provider Name (Legal Business Name): LEAH HOOEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 E PARIS AVE SE
GRAND RAPIDS MI
49546-6204
US

IV. Provider business mailing address

1740 E PARIS AVE SE
GRAND RAPIDS MI
49546-6204
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-5600
  • Fax: 616-949-6571
Mailing address:
  • Phone: 616-949-5600
  • Fax: 616-949-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS16334
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number5101027178
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: