Healthcare Provider Details

I. General information

NPI: 1407112014
Provider Name (Legal Business Name): SCOTT MICHAEL LEYKAUF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5253
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4817
  • Fax:
Mailing address:
  • Phone: 914-365-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704202915
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: