Provider Demographics
NPI:1417044967
Name:LEITGEB, MONIKA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:MARIE
Last Name:LEITGEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6208
Practice Address - Street 1:7335 WESTSHIRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-9703
Practice Address - Country:US
Practice Address - Phone:517-622-2788
Practice Address - Fax:517-622-0460
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853301965OtherBCBS INDIVIDUAL PIN
MI3203034Medicaid
MIG19039Medicare UPIN
MIOM16210003Medicare ID - Type Unspecified