MEDICARE: LESLIE A RILEY 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	207R00000X	Internal Medicine Physician	28162	IA

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	:	1689662306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE A RILEY MD

Provider Business Mailing Address
First Line	:	3 LIONS DR
Second Line	:	FAMILY CARE CENTER NORTH LIBERTY
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9575
Country	:	US
Telephone Number	:	319-626-5680
Fax Number	:	319-626-5687

Provider Business Practice Location Address
First Line	:	3 LIONS DR
Second Line	:	FAMILY CARE CENTER NORTH LIBERTY
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9575
Country	:	US
Telephone Number	:	319-626-5680
Fax Number	:	319-626-5687

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	03/12/2008

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Directions to “ LESLIE A RILEY MD” Practice Location

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