Provider Demographics
NPI:1427814474
Name:LILES, LESLIE LOUISE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LOUISE
Last Name:LILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8569 DAN SMITH RD
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-8509
Mailing Address - Country:US
Mailing Address - Phone:269-332-6407
Mailing Address - Fax:
Practice Address - Street 1:6418 DEANS HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:BERRIEN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49102-8714
Practice Address - Country:US
Practice Address - Phone:269-815-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist