Provider Demographics
NPI:1912030974
Name:LEONARD YOUROFSKY DPM
Entity Type:Organization
Organization Name:LEONARD YOUROFSKY DPM
Other - Org Name:LEONARD YOUROFSKY DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUROFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-262-3444
Mailing Address - Street 1:25811 W 12 MILE RD
Mailing Address - Street 2:STE 205
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1896
Mailing Address - Country:US
Mailing Address - Phone:248-262-3443
Mailing Address - Fax:248-262-3444
Practice Address - Street 1:25811 W 12 MILE RD
Practice Address - Street 2:STE 205
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1896
Practice Address - Country:US
Practice Address - Phone:248-262-3443
Practice Address - Fax:248-262-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000631213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI131097470Medicaid
MI480F340660OtherBLUECROSS BLUESHIELD
MI480F340660OtherBLUECROSS BLUESHIELD
MI131097470Medicaid