Healthcare Provider Details

I. General information

NPI: 1649651076
Provider Name (Legal Business Name): ARTHUR LEITZKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 LA SIERRA AVE # 1055
RIVERSIDE CA
92505-3528
US

IV. Provider business mailing address

3870 LA SIERRA AVE # 1055
RIVERSIDE CA
92505-3528
US

V. Phone/Fax

Practice location:
  • Phone: 309-541-6816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA143982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: