Provider Demographics
NPI:1144333006
Name:YOUROFSKY, LEONARD (DPM)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:YOUROFSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25811 WEST 12 MILE ROAD
Mailing Address - Street 2:STE 205
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-262-3444
Mailing Address - Fax:248-262-3443
Practice Address - Street 1:25811 WEST 12 MILE ROAD
Practice Address - Street 2:STE 205
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-262-3444
Practice Address - Fax:248-262-3443
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0631213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382162814OtherTAX ID
MI131097470Medicaid
485635351OtherBCBS
5635351Medicare ID - Type Unspecified
MI382162814OtherTAX ID
485635351OtherBCBS