Individual
MS. LEAHTHAN FAYE DOMESHEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
35 MICHIGAN ST NE STE 5201, GRAND RAPIDS, MI 49503-2530
(616) 486-5885
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
4301507922
MI
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
Primary
4301507922
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
DR.0060955
CO
Other
Enumeration date
07/11/2010
Last updated
11/23/2022
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