Provider Demographics
NPI:1871687061
Name:LEACH, GEORGE J (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:LEACH
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Gender:M
Credentials:DO
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Mailing Address - Street 1:20270 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2000
Mailing Address - Country:US
Mailing Address - Phone:248-476-1210
Mailing Address - Fax:248-476-9280
Practice Address - Street 1:20270 MIDDLEBELT RD
Practice Address - Street 2:SUITE 10
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2000
Practice Address - Country:US
Practice Address - Phone:248-476-1210
Practice Address - Fax:248-476-9280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-10-17
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Provider Licenses
StateLicense IDTaxonomies
MI5101006363207RE0101X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4297465/11Medicaid
MI4297465/11Medicaid
B45803Medicare UPIN