Healthcare Provider Details

I. General information

NPI: 1831291640
Provider Name (Legal Business Name): ANTONIO R DELEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S ORTONVILLE RD
ORTONVILLE MI
48462-8676
US

IV. Provider business mailing address

1221 S ORTONVILLE RD
ORTONVILLE MI
48462-8676
US

V. Phone/Fax

Practice location:
  • Phone: 248-627-4978
  • Fax: 248-627-4927
Mailing address:
  • Phone: 248-627-4978
  • Fax: 248-627-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301048944
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: