Provider Demographics
NPI:1902147788
Name:DAVID A LEICHTMAN, M.D., PC
Entity Type:Organization
Organization Name:DAVID A LEICHTMAN, M.D., PC
Other - Org Name:DAVID A LEICHTMAN, M,D,, P,C,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEICHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-732-7069
Mailing Address - Street 1:5216 MIRROR LAKE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1536
Mailing Address - Country:US
Mailing Address - Phone:248-732-7069
Mailing Address - Fax:
Practice Address - Street 1:5216 MIRROR LAKE CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1536
Practice Address - Country:US
Practice Address - Phone:248-732-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035386207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty