Active NPI
Joel K Leib, DO
- Family Medicine Physician
- Waterford, MI
National Provider Identifier
1396708681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- JL005644
- Practice address
- 3560 Pontiac Lake Rd
Waterford, MI 48328-2337 - Phone
- (248) 674-2259
- Fax
- (248) 674-3356
- NPI assigned
- Apr 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | JL005644 | MI | Primary |
Addresses
Primary practice location
3560 Pontiac Lake Rd
Waterford, MI 48328-2337
Mailing address
3560 Pontiac Lake Rd
Waterford, MI 48328-2337
Phone (248) 674-2259
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1121181 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JL005644 | MI | MD | Family Medicine Physician |
Interoperability endpoints
- joel.leib.1@14250.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273795200000",
"number": "1396708681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3560 PONTIAC LAKE RD",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282337",
"telephone_number": "248-674-2259",
"fax_number": "248-674-3356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3560 PONTIAC LAKE RD",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282337",
"telephone_number": "248-674-2259",
"fax_number": "248-674-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIB",
"first_name": "JOEL",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-09",
"last_updated": "2010-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "JL005644",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1121181",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.