Individual
LEILA ETTEFAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
26750 PROVIDENCE PKWY STE 200, NOVI, MI 48374-1212
(866) 974-2673
(866) 939-2673
Mailing address
26750 PROVIDENCE PKWY STE 200, NOVI, MI 48374-1212
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
4301117341
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
4301117341
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2015
Last updated
06/13/2022
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