MEDICARE: JOHNETTE K LEIKAM MD

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	208000000X	Pediatrics Physician	C41599	CA

General Provider Information

NPI Number	:	1407805484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNETTE K LEIKAM MD

Provider Business Mailing Address
First Line	:	1133 E STANLEY BLVD
Second Line	:	#103
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4200
Country	:	US
Telephone Number	:	925-455-5050
Fax Number	:	925-667-2122

Provider Business Practice Location Address
First Line	:	1133 E STANLEY BLVD
Second Line	:	#103
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4200
Country	:	US
Telephone Number	:	925-455-5050
Fax Number	:	925-667-2122

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/14/2016

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