Provider Demographics
NPI:1225522519
Name:LEIDHOLT, NATASHA (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:LEIDHOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 LINCOLN WAY STE 315
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2527
Mailing Address - Country:US
Mailing Address - Phone:208-625-6000
Mailing Address - Fax:208-625-6001
Practice Address - Street 1:2470 SAMPSON ST
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-2469
Practice Address - Fax:208-625-6001
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-15006207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine