Healthcare Provider Details

I. General information

NPI: 1912381435
Provider Name (Legal Business Name): LEILA SIBLANI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N MONROE ST
MONROE MI
48162-2936
US

IV. Provider business mailing address

725 N MONROE ST
MONROE MI
48162-2936
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-2727
  • Fax: 734-242-2745
Mailing address:
  • Phone: 734-242-2727
  • Fax: 734-242-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: