Provider Demographics
NPI:1902819295
Name:LEFF, CARRIE FENTON (DO)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:FENTON
Last Name:LEFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:FENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39475 LEWIS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2977
Mailing Address - Country:US
Mailing Address - Phone:248-374-0502
Mailing Address - Fax:
Practice Address - Street 1:39475 LEWIS DR STE 130
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2977
Practice Address - Country:US
Practice Address - Phone:248-374-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015020208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F31794OtherBCBS OF MI
MI0F31794OtherBCBS OF MI