MEDICARE: LEAH MICHELLE MARCOTTE P.A.

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	363A00000X	Physician Assistant	5601004861	MI

General Provider Information

NPI Number	:	1982731634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MICHELLE MARCOTTE P.A.

Provider Business Mailing Address
First Line	:	29600 S WIXOM RD
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-3430
Country	:	US
Telephone Number	:	248-926-8459
Fax Number	:	248-926-1310

Provider Business Practice Location Address
First Line	:	4929 S TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2027
Country	:	US
Telephone Number	:	313-292-4820
Fax Number	:	313-292-4976

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/29/2022

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