Basic Information
| Provider Information | |||||||||
| NPI: | 1508857822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEPOR | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103422100 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1254 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAPEER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484461343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106644531 | ||||||||
| FaxNumber: | 8106677337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 5101005494 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4120726 | 01 | MI | AETNA | OTHER | 3303808 | 05 | MI | MEDICAID | E26492 | 01 | MI | HEALTH NET FEDERAL SERV | OTHER | 5441030 | 01 | MI | BLUE CROSS INDIVIDUAL | OTHER | 3510305 | 01 | MA | HEALTH PLUS | OTHER | C1526 | 01 | MI | MCARE | OTHER | 202187 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 202187 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | E26492 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER |