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General NPI Number Information
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NPI Number | 1871596148
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Entity Type | Individual
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Provider Name | LEONARD S. LEICHUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 2457 CARE DR STE D 100
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3501
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Country | US
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Telephone | 850-841-1166
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Fax | 850-942-5466
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Provider Business Mailing Address
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Address Line | 2457 CARE DR STE D 100
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3501
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Country | US
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Telephone | 850-841-1166
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Fax | 850-942-5466
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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 | 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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