Healthcare Provider Details

I. General information

NPI: 1538124946
Provider Name (Legal Business Name): BARTLOMIEJ TOMASZ LEYKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 120
PHOENIX AZ
85013-3421
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 120
PHOENIX AZ
85013-3421
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-3337
  • Fax: 602-277-3330
Mailing address:
  • Phone: 602-277-3337
  • Fax: 602-277-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number32617
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: