Provider Demographics
NPI:1538242540
Name:LEU, MICHAEL DAVID (ND)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:LEU
Suffix:
Gender:M
Credentials:ND
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:DAVID
Other - Last Name:LEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:407 W A ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3718
Mailing Address - Country:US
Mailing Address - Phone:919-298-9300
Mailing Address - Fax:918-298-9305
Practice Address - Street 1:2965 PARADISE BAY RD
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-8739
Practice Address - Country:US
Practice Address - Phone:206-890-6233
Practice Address - Fax:206-257-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9532183500000X
WANT00000715175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No183500000XPharmacy Service ProvidersPharmacist