Provider Demographics
NPI:1528552700
Name:LEAGAN, MICHAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LEAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 APPIA DR
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-1652
Mailing Address - Country:US
Mailing Address - Phone:713-385-2593
Mailing Address - Fax:
Practice Address - Street 1:636 APPIA DR
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-1652
Practice Address - Country:US
Practice Address - Phone:713-385-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13179540172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver