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General NPI Number Information
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NPI Number | 1083812275
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Entity Type | Organization
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Legal Business Name | GI ASSOCIATES OF TALLAHASSEE P L
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 2457 CARE DR STE D100
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3500
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Country | US
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Telephone | 850-933-1885
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Fax | 850-309-7422
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Provider Business Mailing Address
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Address Line | 2457 CARE DR STE D100
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3500
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Country | US
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Telephone | 850-933-1885
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Fax | 850-309-7422
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEONARD LEICHUS
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Credential | M.D.
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Telephone | 850-933-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME69965
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License Number State | FL
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