Provider Demographics
NPI:1750535696
Name:LEO M. MADARANG MD PC
Entity type:Organization
Organization Name:LEO M. MADARANG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:MARANON
Authorized Official - Last Name:MADARANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-210-7072
Mailing Address - Street 1:820 BOUTELL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1943
Mailing Address - Country:US
Mailing Address - Phone:810-210-7072
Mailing Address - Fax:
Practice Address - Street 1:3200 BEECHER RD
Practice Address - Street 2:STE 02
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3685
Practice Address - Country:US
Practice Address - Phone:810-342-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI35518284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0250315Medicare PIN