MEDICARE: MARK G LEITNER DPM PA

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	213E00000X	Podiatrist	PO3199	FL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3199	FL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2569	FL
4	213ES0131X	Foot Surgery Podiatrist	PO3199	FL
5	213ES0131X	Foot Surgery Podiatrist	PO2569	FL
6	213EP1101X	Primary Podiatric Medicine Podiatrist	PO3199	FL
7	213EP1101X	Primary Podiatric Medicine Podiatrist	PO2569	FL
8	213E00000X	Podiatrist	PO2569	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DG1014	OTHER	FL	RAILROAD 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
2	PO3199	OTHER	FL	MEDICAL LICENSE - JOHNSON
3	65891	OTHER	FL	BCBS - JOHNSON
5	PO2569	OTHER	FL	MEDICAL LICENSE - LEITNER
6	65462	OTHER	FL	BCBS - LEITNER

General Provider Information

NPI Number	:	1376621888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK G LEITNER DPM PA

Provider Business Mailing Address
First Line	:	206 BUCKINGHAM PL
Second Line	:	SUITE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-4910
Country	:	US
Telephone Number	:	813-571-2977
Fax Number	:	813-654-9545

Provider Business Practice Location Address
First Line	:	206 BUCKINGHAM PL
Second Line	:	SUITE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-4910
Country	:	US
Telephone Number	:	813-571-2977
Fax Number	:	813-654-9545

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MARK G LEITNER
Credential	:	DPM
Telephone Number	:	813-571-2977

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/30/2011

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206 BUCKINGHAM PL , SUITE 101
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Directions to “MARK G LEITNER DPM PA ” Practice Location

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