Provider Demographics
NPI:1063484301
Name:LEO KAHN, M.D., P.C.
Entity Type:Organization
Organization Name:LEO KAHN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-216-0201
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:525 N 18TH ST
Practice Address - Street 2:SUITE 602
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4102
Practice Address - Country:US
Practice Address - Phone:602-271-0950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123290Medicaid
AZAZ0811870OtherBLUE CROSS BLUE SHIELD AZ
AZAZ5834OtherHEALTH NET
AZAZ0811870OtherBLUE CROSS BLUE SHIELD AZ