Provider Demographics
NPI:1417940214
Name:LEPERA, RAQUEL (DO)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:LEPERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-5130
Mailing Address - Country:US
Mailing Address - Phone:586-281-6888
Mailing Address - Fax:586-281-6891
Practice Address - Street 1:239 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5130
Practice Address - Country:US
Practice Address - Phone:586-281-6888
Practice Address - Fax:586-281-6891
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010E06195OtherMI BCBS
MI4115482Medicaid
MIG96087Medicare UPIN
MI4115482Medicaid