Provider Demographics
NPI:1316160971
Name:LESLIE MEDICAL CENTER P C
Entity type:Organization
Organization Name:LESLIE MEDICAL CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMUR
Authorized Official - Middle Name:ANUM
Authorized Official - Last Name:BARUTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-589-8252
Mailing Address - Street 1:207 E BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:MI
Mailing Address - Zip Code:49251-9373
Mailing Address - Country:US
Mailing Address - Phone:517-589-8252
Mailing Address - Fax:517-589-5189
Practice Address - Street 1:207 E BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:MI
Practice Address - Zip Code:49251-9373
Practice Address - Country:US
Practice Address - Phone:517-589-8252
Practice Address - Fax:517-589-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052165261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4741000Medicaid
MI4741000Medicaid
MIE91128Medicare UPIN