Provider Demographics
NPI:1972535201
Name:LEONARD L J DIAS MD PC
Entity type:Organization
Organization Name:LEONARD L J DIAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:L J
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-4320
Mailing Address - Street 1:5155 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3021
Mailing Address - Country:US
Mailing Address - Phone:810-230-7532
Mailing Address - Fax:810-230-7764
Practice Address - Street 1:5051 VILLA LINDE PKWY
Practice Address - Street 2:SUITE #29
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3449
Practice Address - Country:US
Practice Address - Phone:810-732-4320
Practice Address - Fax:810-732-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035191207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty