Provider Demographics
NPI:1467692996
Name:LEANDRO F AFRICA, MD, PC
Entity Type:Organization
Organization Name:LEANDRO F AFRICA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEANDRO
Authorized Official - Middle Name:F
Authorized Official - Last Name:AFRICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-228-2303
Mailing Address - Street 1:43361 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1109
Mailing Address - Country:US
Mailing Address - Phone:586-228-2303
Mailing Address - Fax:586-228-2305
Practice Address - Street 1:43361 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1109
Practice Address - Country:US
Practice Address - Phone:586-228-2303
Practice Address - Fax:586-228-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032597208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0504907OtherBLUE CROSS BLUE SHIELD
MI0504907Medicare PIN
0504907OtherBLUE CROSS BLUE SHIELD