Healthcare Provider Details

I. General information

NPI: 1487081204
Provider Name (Legal Business Name): LEON WILLIAM ZECH JR. R.N., C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19292 SCENIC HARBOR DR
MACOMB MI
48044-2882
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 586-243-5355
  • Fax:
Mailing address:
  • Phone: 313-874-4806
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704270188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: