Provider Demographics
NPI:1396707048
Name:DOREY, LEONARD GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:GORDON
Last Name:DOREY
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 1:25 PLEASANT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3765
Mailing Address - Country:US
Mailing Address - Phone:248-681-6416
Mailing Address - Fax:248-681-6416
Practice Address - Street 1:25 PLEASANT LAKE DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3765
Practice Address - Country:US
Practice Address - Phone:248-681-6416
Practice Address - Fax:248-681-6416
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILD029968207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1829938Medicaid
B44109Medicare UPIN
MI1829938Medicaid