Provider Demographics
NPI:1104378405
Name:KEILMAN, LEAH KATHERINE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHERINE
Last Name:KEILMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22044 OLMSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2754
Mailing Address - Country:US
Mailing Address - Phone:313-614-8401
Mailing Address - Fax:
Practice Address - Street 1:22044 OLMSTEAD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2754
Practice Address - Country:US
Practice Address - Phone:313-614-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIK455493461080247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other