Provider Demographics
NPI:1205896032
Name:LEPAK, CYNTHIA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:LEPAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 EDGEWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4434
Mailing Address - Country:US
Mailing Address - Phone:586-381-5960
Mailing Address - Fax:
Practice Address - Street 1:3492 EDGEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4434
Practice Address - Country:US
Practice Address - Phone:586-381-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066198207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICL066198OtherBC/BS OF MI
MI104308540Medicaid
MI103481640Medicaid
MI104175248Medicaid