Provider Demographics
NPI:1285617613
Name:SALOT WEBSTER, LEEANN (MD)
Entity type:Individual
Prefix:MRS
First Name:LEEANN
Middle Name:
Last Name:SALOT WEBSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:SALOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1266 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-739-9009
Mailing Address - Fax:231-733-0566
Practice Address - Street 1:1266 EAST SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-739-9009
Practice Address - Fax:231-733-0566
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057650207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3289843Medicaid
G14055Medicare UPIN
MI3289843Medicaid