Provider Demographics
NPI:1245438134
Name:LEAHY, CARA BONINE (DO)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:BONINE
Last Name:LEAHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:LOUISE
Other - Last Name:BONINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:819 N SHIAWASSEE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1601
Mailing Address - Country:US
Mailing Address - Phone:989-723-1390
Mailing Address - Fax:989-725-1415
Practice Address - Street 1:819 N SHIAWASSEE ST STE 110
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1601
Practice Address - Country:US
Practice Address - Phone:989-723-1390
Practice Address - Fax:989-725-1415
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010172712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245438134Medicaid
MI1245438134Medicaid