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General NPI Number Information
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NPI Number | 1598028334
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Entity Type | Organization
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Legal Business Name | GEORGE J LEACH D O P C
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 20270 MIDDLEBELT RD SUITE 10
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City | LIVONIA
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State | MI
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Zip | 48152-2000
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Country | US
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Telephone | 248-476-1210
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Fax | 248-476-9280
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Provider Business Mailing Address
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Address Line | 20270 MIDDLEBELT RD SUITE 10
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City | LIVONIA
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State | MI
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Zip | 48152-2000
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Country | US
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Telephone | 248-476-1210
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Fax | 248-476-9280
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Authorized Official
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Title or Position | ENDOCRINOLOGY
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Name | DR. GEORGE JAY LEACH
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Credential | D.O.
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Telephone | 248-476-1210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | GL006363
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License Number State | MI
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