Provider Demographics
NPI:1326859646
Name:CROSS, LEON
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-8926
Mailing Address - Country:US
Mailing Address - Phone:517-414-3423
Mailing Address - Fax:517-938-5948
Practice Address - Street 1:119 BINGHAM DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-8926
Practice Address - Country:US
Practice Address - Phone:517-414-3423
Practice Address - Fax:517-938-5948
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program