MEDICARE: NICOLO LEONE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5101011680	MI

General Provider Information

NPI Number	:	1063482099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLO LEONE DO

Provider Business Mailing Address
First Line	:	PO BOX 670660
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-0660
Country	:	US
Telephone Number	:	866-321-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 KERCHEVAL AVE
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3610
Country	:	US
Telephone Number	:	313-640-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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Directions to “ NICOLO LEONE DO” Practice Location

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