MEDICARE: MR. RAYMOND B LEIDICH 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	208800000X	Urology Physician	04-30944	KS

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841262938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND B LEIDICH MD

Provider Business Mailing Address
First Line	:	2134 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2012
Country	:	US
Telephone Number	:	209-339-9036
Fax Number	:	209-339-1901

Provider Business Practice Location Address
First Line	:	2134 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2012
Country	:	US
Telephone Number	:	620-624-1500
Fax Number	:	620-624-1501

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	10/13/2016

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Directions to “ MR. RAYMOND B LEIDICH MD” Practice Location

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