Healthcare Provider Details

I. General information

NPI: 1184683781
Provider Name (Legal Business Name): JOHN MICHAEL LECLAIRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4446 CHERRYWOOD CT
NORTON SHORES MI
49441-4808
US

IV. Provider business mailing address

4446 CHERRYWOOD CT
NORTON SHORES MI
49441-4808
US

V. Phone/Fax

Practice location:
  • Phone: 231-798-2713
  • Fax:
Mailing address:
  • Phone: 231-798-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number4301038974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: