Healthcare Provider Details

I. General information

NPI: 1962609974
Provider Name (Legal Business Name): STUART LEFF DPM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25915 HARPER AVE
SAINT CLAIR SHORES MI
48081-3770
US

IV. Provider business mailing address

25915 HARPER AVE
SAINT CLAIR SHORES MI
48081-3770
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-6640
  • Fax: 586-776-2144
Mailing address:
  • Phone: 586-776-6640
  • Fax: 586-776-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000543
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number5901000543
License Number StateMI

VIII. Authorized Official

Name: DR. STUART GERALD LEFF
Title or Position: PRESIDENT
Credential: DPM
Phone: 586-776-6640