Provider Demographics
NPI:1528347622
Name:LEJA, JACQUELINE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANN
Last Name:LEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE - UHC 5D - MAILBOX #226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4405
Practice Address - Fax:313-966-0665
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099138207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine