Individual
LEO VILLAVICENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
1871 LAKEWOOD DR, TROY, MI 48083-5520
(248) 722-2368
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
4704195807
MI
Other
Enumeration date
04/10/2024
Last updated
04/10/2024
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