Provider Demographics
NPI:1508857822
Name:LEPOR, PAUL D (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:LEPOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-2100
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1254 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1343
Practice Address - Country:US
Practice Address - Phone:810-664-4531
Practice Address - Fax:810-667-7337
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4120726OtherAETNA
MI3303808Medicaid
MIE26492OtherHEALTH NET FEDERAL SERV
MI5441030OtherBLUE CROSS INDIVIDUAL
MA3510305OtherHEALTH PLUS
MIC1526OtherMCARE
MI202187OtherMCLAREN HEALTH PLAN
MI202187OtherHEALTH ADVANTAGE NETWORK
MIE26492OtherHEALTH ALLIANCE PLAN
MI202187OtherMCLAREN HEALTH PLAN
MI3303808Medicaid