MEDICARE: DR. KEVIN O LESLIE M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	23690	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386626257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN O LESLIE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 42210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85080-2210
Country	:	US
Telephone Number	:	623-266-7770
Fax Number	:	623-322-4639

Provider Business Practice Location Address
First Line	:	424 S 56TH ST STE 120
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2108
Country	:	US
Telephone Number	:	602-685-5211
Fax Number	:	602-685-5325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/04/2020

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