Individual
LEEZA FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 MACK AVE STE 4514, DETROIT, MI 48201-2427
(313) 577-4723
Mailing address
33708 LIPKE ST, CLINTON TOWNSHIP, MI 48035-3618
(586) 846-1282
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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