Healthcare Provider Details

I. General information

NPI: 1891724894
Provider Name (Legal Business Name): BORIS J LEHETA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25100 KELLY RD
ROSEVILLE MI
48066-4910
US

IV. Provider business mailing address

25100 KELLY RD
ROSEVILLE MI
48066-4910
US

V. Phone/Fax

Practice location:
  • Phone: 586-771-7440
  • Fax: 586-771-9966
Mailing address:
  • Phone: 586-771-7440
  • Fax: 586-771-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBL049688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: