Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Leisa Dettloff

Individual provider Family Nurse Practitioner · NPI 1972156818

Leisa Dettloff is a Nurse Practitioner in Troy, Michigan. Qualified in 2018, 8 years ago. Practices with Beaumont Medical Group Hospital Based Services, a 572-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
8
Licensed in
MI
In the registry since
2019
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Practice location Address checks out

44201 Dequindre Rd
Troy, MI 48085-1117
Phone: (248) 964-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 4704292580 (MI)

Record details

NPI number1972156818
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 19, 2019
Last updated in NPPESJuly 15, 2022
Certification dateJuly 15, 2022
Mailing address14214 Moravian Manor Cir, Sterling Heights, MI 48312-5796

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Beaumont Medical Group Hospital Based Services — 572 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Troy