MEDICARE: MR. LESLIE SIMPSON JR.

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	2278S1500X	SNF/Subacute Care Certified Respiratory Therapist

General Provider Information

NPI Number	:	1164205787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LESLIE SIMPSON JR.

Provider Business Mailing Address
First Line	:	18681 SAN JUAN DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2173
Country	:	US
Telephone Number	:	313-247-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	18681 SAN JUAN DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2173
Country	:	US
Telephone Number	:	313-247-8327
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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Directions to “ MR. LESLIE SIMPSON JR. ” Practice Location

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