Provider Demographics
NPI:1356472435
Name:NICHOLAS LEONE, M.D., P.C.
Entity Type:Organization
Organization Name:NICHOLAS LEONE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-6550
Mailing Address - Street 1:39400 GARFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4096
Mailing Address - Country:US
Mailing Address - Phone:586-286-6550
Mailing Address - Fax:586-286-1843
Practice Address - Street 1:39400 GARFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4096
Practice Address - Country:US
Practice Address - Phone:586-286-6550
Practice Address - Fax:586-286-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057966207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO1563OtherBCBS GROUP