Provider Demographics
NPI:1194568782
Name:ETER, LEILA (MD)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:ETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 SIGNATURE BLVD APT J
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6600
Mailing Address - Country:US
Mailing Address - Phone:313-663-9515
Mailing Address - Fax:
Practice Address - Street 1:200 ARNET ST STE 200
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5753
Practice Address - Country:US
Practice Address - Phone:313-663-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052557390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program