MEDICARE: LEAH M. PIKE, M.D., PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XP3100X	Pediatric Orthopaedic Surgery Physician	G83814	CA

General Provider Information

NPI Number	:	1154551026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAH M. PIKE, M.D., PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 30525
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90853-0525
Country	:	US
Telephone Number	:	562-936-9200
Fax Number	:	562-936-9201

Provider Business Practice Location Address
First Line	:	3742 KATELLA AVE
Second Line	:	SUITE 303
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3102
Country	:	US
Telephone Number	:	562-936-9200
Fax Number	:	562-936-9201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEAH MARIE PIKE
Credential	:	M.D.
Telephone Number	:	562-936-9200

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	04/30/2012

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