Provider Demographics
NPI:1144209149
Name:MOOI, LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:MOOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-8992
Mailing Address - Country:US
Mailing Address - Phone:906-341-2153
Mailing Address - Fax:906-341-3299
Practice Address - Street 1:7870W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-8992
Practice Address - Country:US
Practice Address - Phone:906-341-2153
Practice Address - Fax:906-341-3299
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1960890Medicaid
MIOG71004OtherRHC BCBS NUMBER
MI1960890Medicaid
MIE61020Medicare UPIN
MI23-8588Medicare ID - Type UnspecifiedRHC GROUP BILLING NUMBER