Provider Demographics
NPI:1659393833
Name:HAROLD, DAVID LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEONARD
Last Name:HAROLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:2346 WALNUT LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3740
Practice Address - Country:US
Practice Address - Phone:248-408-0599
Practice Address - Fax:248-322-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDHO32177174400000X
MH4301032177208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB9133OtherRAILROAD MEDICARE
MI0E06273OtherBCBSM
MI0E06273OtherBCBSM
MIB47470Medicare UPIN