Healthcare Provider Details

I. General information

NPI: 1568859023
Provider Name (Legal Business Name): ANDREW J LEIKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E BROADWAY STE 100
COLUMBIA MO
65201-7167
US

IV. Provider business mailing address

1705 E BROADWAY STE 100
COLUMBIA MO
65201-7167
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-7800
  • Fax: 573-443-3627
Mailing address:
  • Phone: 573-817-8509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2019043653
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: