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Individual

BRUCE C LEITKAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
490 W BROAD ST, LINDEN, MI 48451-8768
(810) 735-1231
(810) 735-1092
Mailing address
490 W BROAD ST, PO BOX 605, LINDEN, MI 48451-8768
(810) 735-1231
(810) 735-1092

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5101006591
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
015251061
BLUECROSS BLUE SHIELD OF
MI
05
1552457
MI
01
4075401
AETNA
MI
01
M028466
TRICARE
MI
Enumeration date
05/03/2006
Last updated
01/22/2010
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