Provider Demographics
NPI:1669779039
Name:PAUL A LEEP MD PC
Entity type:Organization
Organization Name:PAUL A LEEP MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PROFESSIONAL CORPOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LEEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:906-482-5230
Mailing Address - Street 1:404 SHARON AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1612
Mailing Address - Country:US
Mailing Address - Phone:906-482-5230
Mailing Address - Fax:906-482-5343
Practice Address - Street 1:404 SHARON AVENUE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1612
Practice Address - Country:US
Practice Address - Phone:906-482-5230
Practice Address - Fax:906-482-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
041617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty