Organization
BRUCE C LEITKAM DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE CALVIN LEITKAM DO (OWNE)
(810) 735-1231
Entity
Organization
Contact information
Practice address
490 W BROAD ST, LINDEN, MI 48451-8862
(810) 735-1231
(810) 735-1092
Mailing address
490 W BROAD ST, PO BOX 605, LINDEN, MI 48451-8862
(810) 735-1231
(810) 735-1092
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
BL006591
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1552457
—
MI
01
—
5251061
BCBS
MI
Enumeration date
07/01/2010
Last updated
07/01/2010
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