Provider Demographics
NPI:1174578801
Name:POMPY, LESLY (MD)
Entity type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:POMPY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MACOMB ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2900
Mailing Address - Country:US
Mailing Address - Phone:734-242-9482
Mailing Address - Fax:734-242-6503
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:SUITE 410
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2900
Practice Address - Country:US
Practice Address - Phone:734-242-9482
Practice Address - Fax:734-242-6503
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058720207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2371008Medicaid
4470749OtherAETNA
MI2826592-10Medicaid
MI4464106-10Medicaid
4470749OtherAETNA
MI720000288Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI0N62500Medicare ID - Type Unspecified
MIE86029002Medicare ID - Type Unspecified
MI0E86029002Medicare ID - Type Unspecified