Provider Demographics
NPI:1467709972
Name:LESLIE, MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9348 GRAND CORDERA PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7001
Mailing Address - Country:US
Mailing Address - Phone:719-355-1585
Mailing Address - Fax:719-623-2983
Practice Address - Street 1:9348 GRAND CORDERA PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7001
Practice Address - Country:US
Practice Address - Phone:719-355-1585
Practice Address - Fax:719-623-2983
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6857207N00000X
CODR.0053411207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology