Provider Demographics
NPI:1942428297
Name:BAUGH, LESLIE DENISE (PA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DENISE
Last Name:BAUGH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7700 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2411
Mailing Address - Country:US
Mailing Address - Phone:313-202-8660
Mailing Address - Fax:313-202-8653
Practice Address - Street 1:2888 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2612
Practice Address - Country:US
Practice Address - Phone:313-875-5049
Practice Address - Fax:313-875-5728
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601002565OtherLICENSE
MI5601002565OtherLICENSE