Healthcare Provider Details

I. General information

NPI: 1942715321
Provider Name (Legal Business Name): LEO R MURSKYJ MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E WATTLES RD STE 101
TROY MI
48085-5099
US

IV. Provider business mailing address

1950 E WATTLES RD STE 101
TROY MI
48085-5099
US

V. Phone/Fax

Practice location:
  • Phone: 248-740-8000
  • Fax: 248-740-1355
Mailing address:
  • Phone: 248-740-8000
  • Fax: 248-740-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301050124
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301050124
License Number StateMI

VIII. Authorized Official

Name: LEO R MURSKYJ
Title or Position: OWNER/MD
Credential: MD
Phone: 248-740-8000