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General NPI Number Information
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NPI Number | 1982072096
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Entity Type | Organization
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Legal Business Name | LEO J ANKENBRANDT MD
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 12801 N 16TH DR
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City | PHOENIX
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State | AZ
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Zip | 85029-2802
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Country | US
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Telephone | 602-866-1543
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Fax | 602-866-1543
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Provider Business Mailing Address
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Address Line | 12801 N 16TH DR
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City | PHOENIX
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State | AZ
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Zip | 85029-2802
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Country | US
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Telephone | 602-866-1543
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Fax | 602-866-1543
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Authorized Official
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Title or Position | SOLE PROPRIOTER
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Name | DR. LEO JEROME ANKENBRANDT
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Credential | MD
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Telephone | 602-866-1543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 3720
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License Number State | AZ
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