Provider Demographics
NPI:1841299179
Name:LEEDLE, JAMES D (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:LEEDLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11460 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2710
Mailing Address - Country:US
Mailing Address - Phone:810-632-7700
Mailing Address - Fax:810-632-9770
Practice Address - Street 1:11460 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2710
Practice Address - Country:US
Practice Address - Phone:810-632-7700
Practice Address - Fax:810-632-9770
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI095579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D700080OtherBC/BS
MIP77386OtherBLUE CARE NETWORK
MI123473OtherCARE CHOICES PPO
MI123473OtherPREFERRED CHOICES
MI290825Medicaid
MI123473OtherCARE CHOICES PPO
MIT33187Medicare UPIN