Healthcare Provider Details

I. General information

NPI: 1497965693
Provider Name (Legal Business Name): LEO MARCAYDA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S COLORADO ST
HOBART IN
46342-5847
US

IV. Provider business mailing address

1230 S COLORADO ST
HOBART IN
46342-5847
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-3051
  • Fax: 219-947-3132
Mailing address:
  • Phone: 219-942-3051
  • Fax: 219-947-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number05003904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: