Provider Demographics
NPI:1942715321
Name:LEO R MURSKYJ MD PLC
Entity Type:Organization
Organization Name:LEO R MURSKYJ MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURSKYJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-740-8000
Mailing Address - Street 1:1950 E WATTLES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-5099
Mailing Address - Country:US
Mailing Address - Phone:248-740-8000
Mailing Address - Fax:248-740-1355
Practice Address - Street 1:1950 E WATTLES RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5099
Practice Address - Country:US
Practice Address - Phone:248-740-8000
Practice Address - Fax:248-740-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050124207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty