Healthcare Provider Details

I. General information

NPI: 1386741510
Provider Name (Legal Business Name): LESLIE DENISE HIGHLAND DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: L. DENISE HIGHLAND D.P.M.

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37767 CHASE RUN DR
STERLING HEIGHTS MI
48310-4000
US

IV. Provider business mailing address

37767 CHASE RUN DR
STERLING HEIGHTS MI
48310-4000
US

V. Phone/Fax

Practice location:
  • Phone: 586-939-0323
  • Fax:
Mailing address:
  • Phone: 586-939-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000965
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: