Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901021634 | MI |
N | 1223P0106X | Oral and Maxillofacial Pathology | 2901021634 | MI |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2952000520 | MI |
NPI | 1235501768 |
---|---|
Provider Name | Yu Leo Lei |
First Address | Toledo, OH 43614-1509 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2015 |
Last Update Date | 08/10/2021 |