Provider Demographics
NPI:1477667590
Name:CETNER, LEONARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:M
Last Name:CETNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6330 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-855-3366
Mailing Address - Fax:248-855-6213
Practice Address - Street 1:6330 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-855-3366
Practice Address - Fax:248-855-6213
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-11-18
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Provider Licenses
StateLicense IDTaxonomies
MI4301080564207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF37225004Medicare PIN