Provider Demographics
NPI:1831122324
Name:LEJA, LORETTA M (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:LEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2267
Mailing Address - Country:US
Mailing Address - Phone:231-597-8192
Mailing Address - Fax:
Practice Address - Street 1:920 S HURON ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2267
Practice Address - Country:US
Practice Address - Phone:231-597-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201541895OtherPRIORITY HEALTH
MIP00183473OtherRAILROAD MEDICARE
MI0801601071OtherBCBS
MI4559907Medicaid
MI201541895OtherPRIORITY HEALTH
MIB44770Medicare UPIN
MIP08020001Medicare PIN