Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 05633 | IA |
NPI | 1154457885 |
---|---|
Provider Name | Dr. Michael Henry Leuck |
First Address | West Des Moines, IA 50266-1430 |
Second Address | West Des Moines, IA 50266-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |