Provider Demographics
NPI:1881663110
Name:MCLEOD, MICHAEL KENT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENT
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:# A109F
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4660 SOUTH HAGADORN ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-267-2462
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039382208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0208151371OtherBCBS
MI4183947Medicaid
MI1881663110Medicaid
MI4183947Medicaid
MIC36179041Medicare PIN