Provider Demographics
NPI:1578536009
Name:DE LEON, ELIEZER R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:R
Last Name:DE LEON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:17000 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4258
Practice Address - Country:US
Practice Address - Phone:313-982-4351
Practice Address - Fax:313-982-4370
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-10-22
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Provider Licenses
StateLicense IDTaxonomies
MI038489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID90205Medicare UPIN