Healthcare Provider Details

I. General information

NPI: 1821084146
Provider Name (Legal Business Name): ELLEN LOUISE LEEKE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN LOUISE PARTRICH D.O.

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY PRACTICE, 48TH MDG/MDOS/SGOPF RAF LAKENHEATH
APO AE
09464
GB

IV. Provider business mailing address

12 THE CROFTERS
STRETHAM CAMBRIDGESHIRE
CB6 3NF
GB

V. Phone/Fax

Practice location:
  • Phone: 011441638528010
  • Fax: 011441638528022
Mailing address:
  • Phone: 011441353648962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02002228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: