Provider Demographics
NPI:1790045433
Name:LEGER-MOORE MANAGEMENT CONSULTANT, LLC
Entity Type:Organization
Organization Name:LEGER-MOORE MANAGEMENT CONSULTANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:586-531-8882
Mailing Address - Street 1:2422 JOLLY RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3686
Mailing Address - Country:US
Mailing Address - Phone:517-349-9330
Mailing Address - Fax:517-349-7131
Practice Address - Street 1:2422 JOLLY RD
Practice Address - Street 2:STE. 200
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3686
Practice Address - Country:US
Practice Address - Phone:517-349-9330
Practice Address - Fax:517-349-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100643208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty