Provider Demographics
NPI:1336105758
Name:KATHLEEN LEBER, MD PA
Entity Type:Organization
Organization Name:KATHLEEN LEBER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-350-0700
Mailing Address - Street 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4168
Mailing Address - Country:US
Mailing Address - Phone:813-350-0700
Mailing Address - Fax:813-350-0703
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4168
Practice Address - Country:US
Practice Address - Phone:813-350-0700
Practice Address - Fax:813-350-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9655Medicare PIN