Provider Demographics
NPI:1992786271
Name:LEO, HARVEY L (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:L
Last Name:LEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4350 JACKSON RD
Mailing Address - Street 2:STE 370
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1889
Mailing Address - Country:US
Mailing Address - Phone:734-434-3007
Mailing Address - Fax:734-434-6317
Practice Address - Street 1:2000 N HURON RIVER DR STE 200
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1791
Practice Address - Country:US
Practice Address - Phone:734-434-3007
Practice Address - Fax:734-434-6317
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083181207KA0200X, 208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104630637Medicaid
MI104631625Medicaid
H61998Medicare UPIN
MI0H16377006Medicare ID - Type Unspecified
MI104630637Medicaid