Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301059106 | MI |
NPI | 1003883539 |
---|---|
Provider Name | Marlo Leonen |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Ypsilanti, MI 48197-8633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 26/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G29668 | (02) | MI |