Provider Demographics
NPI:1285672691
Name:MADARANG, LEO MARANON (MD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:MARANON
Last Name:MADARANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BOUTELL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1943
Mailing Address - Country:US
Mailing Address - Phone:810-210-7072
Mailing Address - Fax:
Practice Address - Street 1:3200 BEECHER RD.
Practice Address - Street 2:STE 02
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3685
Practice Address - Country:US
Practice Address - Phone:810-342-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI35518208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2097957Medicaid
MI0250315OtherBLUECARE NETWORK
MI0250315OtherBLUE CROSS BLUE SHIELD OF
MI382817349OtherEMPLOYER ID#
MI0250315OtherBLUECARE NETWORK
MI382817349OtherEMPLOYER ID#