# BRUCE C LEITKAM DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417268764
- **Authorized official:** DR. BRUCE CALVIN LEITKAM DO (OWNE)
- **Authorized official phone:** (810) 735-1231

## Contact information

- **Practice address:** 490 W BROAD ST, LINDEN, MI 48451-8862
- **Practice address phone:** (810) 735-1231
- **Practice address fax:** (810) 735-1092
- **Mailing address:** 490 W BROAD ST, PO BOX 605, LINDEN, MI 48451-8862
- **Mailing address phone:** (810) 735-1231
- **Mailing address fax:** (810) 735-1092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | BL006591 | MI | Yes |

## Other

- **Enumeration date:** 07/01/2010
- **Last updated:** 07/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1552457 | — | MI |
| 01 | — | 5251061 | BCBS | MI |