MEDICARE: DR. LEONARD JOHN PITTALA DO

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	208000000X	Pediatrics Physician	R6A65	MO
2	208D00000X	General Practice Physician	76-00002	KS
3	208D00000X	General Practice Physician	R6A65	MO

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	09731015	OTHER	MO	BCBS OF KANSAS CITY INDIV

General Provider Information

NPI Number	:	1750351888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD JOHN PITTALA DO

Provider Business Mailing Address
First Line	:	2101 CORONA RD
Second Line	:	STE 102
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2582
Country	:	US
Telephone Number	:	573-234-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 CORONA RD
Second Line	:	STE 102
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2582
Country	:	US
Telephone Number	:	573-234-1800
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	05/20/2025

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Directions to “ DR. LEONARD JOHN PITTALA DO” Practice Location

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