Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301074297 | MI |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301074297 | MI |
NPI | 1437199411 |
---|---|
Provider Name | Elizabeth Leary |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 22/02/2021 |