Provider Demographics
NPI:1891059002
Name:SWIDERSKI, LEANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MARIE
Last Name:SWIDERSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEANNE
Other - Middle Name:MARIE
Other - Last Name:LAWWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29150 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2848
Practice Address - Country:US
Practice Address - Phone:734-762-3600
Practice Address - Fax:734-762-3611
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine