Provider Demographics
NPI:1861487159
Name:LEUSCHNER, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LEUSCHNER
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 1:2025 VAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-6904
Mailing Address - Country:US
Mailing Address - Phone:616-396-5235
Mailing Address - Fax:616-396-5380
Practice Address - Street 1:2025 VAN HILL DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-6904
Practice Address - Country:US
Practice Address - Phone:616-396-5235
Practice Address - Fax:616-396-5380
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075059207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIEL075059OtherBCBSM
MI4133598Medicaid
MI4133598Medicaid
MIEL075059OtherBCBSM
MIH04326Medicare UPIN