| Organization Name: | BRUCE C LEITKAM DO PC |
| NPI Number: | 1417268764 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRUCE CALVIN LEITKAM (OWNE) |
| Mailing Address: | 490 W Broad St Linden |
| State: | MI US |
| Postal Code: | 484518862 |
| Phone Number: | 8107351231 |
| Fax Number: | 8107351092 |
| NPI Enumeration Date: | 07/01/2010 |
| NPI Last Update Date: | 07/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | BL006591 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |