Active NPI
Bruce C Leitkam, DO
- General Practice Physician
- Linden, MI
National Provider Identifier
1922066356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 5101006591
- Practice address
- 490 W Broad St
Linden, MI 48451-8768 - Phone
- (810) 735-1231
- Fax
- (810) 735-1092
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 5101006591 | MI | Primary |
Addresses
Primary practice location
490 W Broad St
Linden, MI 48451-8768
Mailing address
490 W Broad St
PO Box 605
Linden, MI 48451-8768
Phone (810) 735-1231
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4075401 | Other | MI | AETNA |
| 1552457 | Medicaid | MI | |
| M028466 | Other | MI | TRICARE |
| 015251061 | Other | MI | BLUECROSS BLUE SHIELD OF |
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 |
|---|---|---|---|
| 5101006591 | MI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264118400000",
"number": "1922066356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "490 W BROAD ST",
"address_2": "PO BOX 605",
"city": "LINDEN",
"state": "MI",
"postal_code": "484518768",
"telephone_number": "810-735-1231",
"fax_number": "810-735-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 W BROAD ST",
"city": "LINDEN",
"state": "MI",
"postal_code": "484518768",
"telephone_number": "810-735-1231",
"fax_number": "810-735-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEITKAM",
"first_name": "BRUCE",
"middle_name": "C",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2010-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "5101006591",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4075401",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1552457",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "M028466",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUE SHIELD OF",
"identifier": "015251061",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Linden, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.