Provider Demographics
NPI:1174511471
Name:LEEDS, PHILLIP B (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:B
Last Name:LEEDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:21 SE THIRD STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1421
Practice Address - Country:US
Practice Address - Phone:812-473-0181
Practice Address - Fax:812-473-5822
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043831A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00160377OtherRAILROAD MEDICARE
IN200086630Medicaid
IN000000343450OtherBC
IN262420FMedicare PIN
IN220050AMedicare PIN
INP00160377OtherRAILROAD MEDICARE