MEDICARE: DR. MARK G LEITNER DPM

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	213E00000X	Podiatrist	PO2569	FL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2569	FL
3	213ES0131X	Foot Surgery Podiatrist	PO2569	FL
4	213EP1101X	Primary Podiatric Medicine Podiatrist	PO2569	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00415451	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	202703	OTHER	FL	AMERIGROUP
3	10172301	OTHER	FL	CITRUS
4	864973	OTHER	FL	UHC
5	76166	OTHER	FL	BEECHSTREET
6	PO2569	OTHER		LICENSE NO
7	1006007	OTHER	FL	HEALTHNET/CAREPLUS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	4961325	OTHER	FL	CIGNA
10	65462	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1962401067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK G LEITNER DPM

Provider Business Mailing Address
First Line	:	206 BUCKINGHAM PL
Second Line	:	SUITE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-4910
Country	:	US
Telephone Number	:	813-571-2977
Fax Number	:	813-654-9545

Provider Business Practice Location Address
First Line	:	206 BUCKINGHAM PL
Second Line	:	SUITE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-4910
Country	:	US
Telephone Number	:	813-571-2977
Fax Number	:	813-654-9545

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/30/2011

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Directions to “ DR. MARK G LEITNER DPM” Practice Location

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