Provider Demographics
NPI:1457485013
Name:CAYDE LESLIE, MAYUMI L (MD)
Entity type:Individual
Prefix:
First Name:MAYUMI
Middle Name:L
Last Name:CAYDE LESLIE
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:4111 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7803
Practice Address - Country:US
Practice Address - Phone:219-873-2919
Practice Address - Fax:219-873-2909
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53311207Q00000X
IN01074116A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI453000626Medicare PIN
WI710180709Medicare PIN