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General NPI Number Information
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NPI Number | 1720511942
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Entity Type | Individual
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Provider Name | SHANNON KATHLEEN LEIKERT D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 4288 3 MILE RD NW
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City | WALKER
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State | MI
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Zip | 49534-7596
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Country | US
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Telephone | 616-458-3677
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Fax | 616-459-6850
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Provider Business Mailing Address
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Address Line | 4288 3 MILE RD NW
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City | WALKER
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State | MI
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Zip | 49534-7596
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Country | US
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Telephone | 616-458-3677
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Fax | 616-459-5850
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5101023233
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License Number State | MI
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