=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992921753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUART LEFF, DPM,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 05/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2405 E 14 MILE RD
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48310-5961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-268-6110
-----------------------------------------------------
Fax | 586-264-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2405 E 14 MILE RD
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48310-5961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-268-6110
-----------------------------------------------------
Fax | 586-264-1155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STUART GERALD LEFF
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 586-268-6110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 5901000543
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------