Provider Demographics
NPI:1033231253
Name:MANCINI, LEANNE M (DO)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:M
Last Name:MANCINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2500 NILES ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-429-5000
Mailing Address - Fax:269-429-2598
Practice Address - Street 1:2500 NILES ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:ST JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-429-5000
Practice Address - Fax:269-429-2598
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315029748OtherCONTROLLED SUB
MIFM0152140OtherDEA