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General NPI Number Information
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NPI Number | 1922066356
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Entity Type | Individual
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Provider Name | BRUCE C LEITKAM DO
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 490 W BROAD ST
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City | LINDEN
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State | MI
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Zip | 48451-8768
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Country | US
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Telephone | 810-735-1231
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Fax | 810-735-1092
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Provider Business Mailing Address
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Address Line | 490 W BROAD ST PO BOX 605
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City | LINDEN
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State | MI
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Zip | 48451-8768
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Country | US
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Telephone | 810-735-1231
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Fax | 810-735-1092
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5101006591
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License Number State | MI
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