Provider Demographics
NPI:1386741510
Name:HIGHLAND, LESLIE DENISE (DPM)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:DENISE
Last Name:HIGHLAND
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:L.
Other - Middle Name:DENISE
Other - Last Name:HIGHLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:37767 CHASE RUN DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4000
Mailing Address - Country:US
Mailing Address - Phone:586-939-0323
Mailing Address - Fax:
Practice Address - Street 1:37767 CHASE RUN DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4000
Practice Address - Country:US
Practice Address - Phone:586-939-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000965213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4855014780OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
5505043Medicare ID - Type Unspecified
4855014780OtherBLUE CROSS BLUE SHIELD OF MICHIGAN