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Individual
BRUCE C LEITKAM
Active
Individual
BRUCE C LEITKAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5101006591
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015251061
BLUECROSS BLUE SHIELD OF
MI
05
—
1552457
—
MI
01
—
4075401
AETNA
MI
01
—
M028466
TRICARE
MI
Enumeration date
05/03/2006
Last updated
01/22/2010
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