Individual
DR. LESLIE MARIE JURECKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 MICHIGAN ST NE, MC 169, GRAND RAPIDS, MI 49503-2560
(616) 391-5275
Mailing address
100 MICHIGAN ST NE, MC 169, GRAND RAPIDS, MI 49503-2560
(616) 391-5275
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301095239
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174789101
—
MI
Enumeration date
07/30/2008
Last updated
08/06/2012
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