Healthcare Provider Details

I. General information

NPI: 1528564408
Provider Name (Legal Business Name): SARAH LYNN LEO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 N WELLNESS DR STE 180
HOLLAND MI
49424-8047
US

IV. Provider business mailing address

12201 HIBNER RD
HARTLAND MI
48353-1410
US

V. Phone/Fax

Practice location:
  • Phone: 616-738-4262
  • Fax:
Mailing address:
  • Phone: 810-516-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number5101027751
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number5101027751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: