MEDICARE: DR. KIMBERLY A LEACH DPM

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	0566	AZ

General Provider Information

NPI Number	:	1538139449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY A LEACH DPM

Provider Business Mailing Address
First Line	:	838 W ELLIOT RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5162
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:	480-371-1121

Provider Business Practice Location Address
First Line	:	4566 E INVERNESS AVE STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4633
Country	:	US
Telephone Number	:	480-985-6000
Fax Number	:	480-985-8641

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	08/08/2022

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