Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 4351042777 | MI |
NPI | 1124558457 |
---|---|
Provider Name | Georgina Leamon |
First Address | Berkley, MI 48072-1868 |
Second Address | Berkley, MI 48072-1868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 24/06/2021 |