Provider Demographics
NPI:1467464834
Name:LEONE, LUCIA A (DO)
Entity type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:A
Last Name:LEONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22021 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1847
Mailing Address - Country:US
Mailing Address - Phone:313-291-4444
Mailing Address - Fax:313-291-7540
Practice Address - Street 1:2901 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2472
Practice Address - Country:US
Practice Address - Phone:734-676-6644
Practice Address - Fax:734-675-1858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3239618Medicaid
G13667Medicare UPIN
MI3239618Medicaid