Provider Demographics
NPI:1093786378
Name:LEEP, PAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:LEEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:A
Other - Last Name:LEEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDPC
Mailing Address - Street 1:404 W SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1980
Mailing Address - Country:US
Mailing Address - Phone:906-482-5230
Mailing Address - Fax:906-482-5343
Practice Address - Street 1:404 W SHARON AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1980
Practice Address - Country:US
Practice Address - Phone:906-482-5230
Practice Address - Fax:906-482-5343
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI041617207W00000X
MI4301041617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114388Medicaid
1803100112OtherBCBS OF MICHIGAN
B45290Medicare UPIN
0310011Medicare ID - Type Unspecified