MEDICARE: RONALD D LEIDENFROST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	R6074	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00244609	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215936745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD D LEIDENFROST MD

Provider Business Mailing Address
First Line	:	222 S WOODS MILL RD
Second Line	:	SUITE 550-N
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3625
Country	:	US
Telephone Number	:	314-434-3049
Fax Number	:	314-205-6916

Provider Business Practice Location Address
First Line	:	222 S WOODS MILL RD
Second Line	:	SUITE 550-N
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3625
Country	:	US
Telephone Number	:	314-434-3049
Fax Number	:	314-205-6916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/01/2015

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Directions to “ RONALD D LEIDENFROST MD” Practice Location

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