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NPI Code Detail

MEDICARE: MYRNA S DELEON MD

MEDICARE: MYRNA S DELEON MD
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
12080P0203XPediatric Critical Care Medicine Physician4301046496MI

General Provider Information

NPI Number : 1679577415
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRNA S DELEON MD
Provider Business Mailing Address
First Line : 25925 TELEGRAPH RD
Second Line : STE 210
City : SOUTHFIELD
State : MI
Zip : 48034-2527
Country : US
Telephone Number : 248-746-0342
Fax Number : 248-746-0308
Provider Business Practice Location Address
First Line : 16001 W 9 MILE RD
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-849-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/18/2007

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