Provider Demographics
NPI:1659471787
Name:MURSKYJ, LEO R (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:R
Last Name:MURSKYJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E WATTLES STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-740-8000
Mailing Address - Fax:248-740-1355
Practice Address - Street 1:1950 E WATTLES RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5099
Practice Address - Country:US
Practice Address - Phone:248-740-8000
Practice Address - Fax:248-740-1355
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050124207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1105005681OtherBCBSMI PERSONAL PIN
MI200158731OtherWARREN TAX ID
MI381898230OtherSCHOENHERR TAX ID
MI4218953Medicaid
MI110E011830OtherSCHOENHERR BCBS GR PIN
MI4749035Medicaid
MI0E00425OtherBLUE CROSS BLUE SHIELD OF MI
MI700E001650OtherWARREN BCBS GR PIN
MI110E011830OtherSCHOENHERR BCBS GR PIN
MI4749035Medicaid
MIF34972030Medicare PIN
MI1105005681OtherBCBSMI PERSONAL PIN