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General NPI Number Information
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NPI Number | 1477048106
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Entity Type | Organization
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Legal Business Name | STEVEN LECKIE MD LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 68 ALDEN ST
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City | DUXBURY
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State | MA
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Zip | 02332
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Country | US
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Telephone | 800-310-7334
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Fax | 469-453-3374
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Provider Business Mailing Address
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Address Line | DEPT # 880236 PO BOX 29650
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City | PHOENIX, AZ 85038-9650
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State | AZ
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Zip | 85038-9650
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Country | US
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Telephone | 800-310-7334
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEVEN LECKIE
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Credential | MD
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Telephone | 800-310-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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