Healthcare Provider Details

I. General information

NPI: 1568579530
Provider Name (Legal Business Name): LUCI LEYKUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 38TH ST STE 101
AUSTIN TX
78705-9918
US

IV. Provider business mailing address

7703 FLOYD CURL DRIVE, RM 5.069R UTHSCSA, DEPT. OF MEDICINE
SAN ANTONIO TX
78229
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-8375
  • Fax:
Mailing address:
  • Phone: 210-358-4000
  • Fax: 210-257-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9780
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: