Doctor Name: | MICHAEL LEASURE |
NPI Number: | 1700144524 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 60552997 |
Business Practice Address: | 1003 Koala Ave Omak, WA - 988419247 |
Business Phone Number: | 5094225700 |
Business Fax Number: | 5094227680 |
Mailing Address: | Po Box 1340, OKANOGAN |
State: | WA |
Postal Code: | 988401340 |
Phone Number: | 5094225700 |
Fax Number: | 5094227680 |
NPI Enumeration Date: | 04/30/2012 |
NPI Last Update Date: | 07/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 60552997 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |