Provider Demographics
NPI:1407244130
Name:LESLIE, DANIEL R (CPED)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:LESLIE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E CORK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4823
Mailing Address - Country:US
Mailing Address - Phone:269-349-2247
Mailing Address - Fax:
Practice Address - Street 1:1016 E CORK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4823
Practice Address - Country:US
Practice Address - Phone:269-349-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICPED4105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist