Provider Demographics
NPI:1346884053
Name:ALAIWAT, LEANNA M
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:M
Last Name:ALAIWAT
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 1:28250 CARLTON WAY DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2634
Mailing Address - Country:US
Mailing Address - Phone:734-277-5035
Mailing Address - Fax:
Practice Address - Street 1:25150 FORD RD STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3163
Practice Address - Country:US
Practice Address - Phone:313-277-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant