Provider Demographics
NPI:1073658480
Name:LEBLANC, BELINDA KOO (MD)
Entity Type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:KOO
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BELINDA
Other - Middle Name:
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2215 FULLER RD # 116C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-845-3471
Mailing Address - Fax:734-222-7648
Practice Address - Street 1:2215 FULLER RD # 116C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-3471
Practice Address - Fax:734-222-7648
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010835052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5307118Medicaid
MI5307118Medicaid