Provider Demographics
NPI:1093862682
Name:SWISTAK, LEONARD EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:EUGENE
Last Name:SWISTAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2673
Mailing Address - Country:US
Mailing Address - Phone:248-371-2255
Mailing Address - Fax:
Practice Address - Street 1:1525 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2673
Practice Address - Country:US
Practice Address - Phone:248-371-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F34793Medicare UPIN