Healthcare Provider Details

I. General information

NPI: 1326782269
Provider Name (Legal Business Name): ERIN GABRIELLE LEACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST SUITE A609
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

100 MICHIGAN ST SUITE A609
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-732-6200
  • Fax:
Mailing address:
  • Phone: 616-732-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number4301514461
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301514461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: