Provider Demographics
NPI:1841267903
Name:LECEA, GREGORIO EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:EDUARDO
Last Name:LECEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HURLEY PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5905
Mailing Address - Country:US
Mailing Address - Phone:810-630-2144
Mailing Address - Fax:
Practice Address - Street 1:2 HURLEY PLZ STE 204
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5905
Practice Address - Country:US
Practice Address - Phone:810-630-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1759468Medicaid
MI1759468Medicaid