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General NPI Number Information
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NPI Number | 1902147788
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Entity Type | Organization
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Legal Business Name | DAVID A LEICHTMAN, M.D., PC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 5216 MIRROR LAKE CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-1536
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Country | US
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Telephone | 248-732-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 5216 MIRROR LAKE CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-1536
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Country | US
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Telephone | 248-732-7069
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID ALLEN LEICHTMAN
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Credential | MD
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Telephone | 248-732-7069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 4301035386
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License Number State | MI
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