Provider Demographics
NPI:1598028334
Name:GEORGE J LEACH D O P C
Entity Type:Organization
Organization Name:GEORGE J LEACH D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-476-1210
Mailing Address - Street 1:20270 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2000
Mailing Address - Country:US
Mailing Address - Phone:248-476-1210
Mailing Address - Fax:248-476-9280
Practice Address - Street 1:20270 MIDDLEBELT RD
Practice Address - Street 2:SUITE 10
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2000
Practice Address - Country:US
Practice Address - Phone:248-476-1210
Practice Address - Fax:248-476-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGL006363207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4297465Medicaid
MIB45803Medicare UPIN