Healthcare Provider Details

I. General information

NPI: 1700457983
Provider Name (Legal Business Name): REGAN DONN LEACH MDHHS CPRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W HOLMES RD STE 200
LANSING MI
48910-0411
US

IV. Provider business mailing address

507 E GANSON ST
JACKSON MI
49201-1609
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-0226
  • Fax:
Mailing address:
  • Phone: 269-599-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: