Provider Demographics
NPI:1407805484
Name:LEIKAM, JOHNETTE K (MD)
Entity Type:Individual
Prefix:
First Name:JOHNETTE
Middle Name:K
Last Name:LEIKAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOHNETTE
Other - Middle Name:LEIKAM
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1133 E STANLEY BLVD
Mailing Address - Street 2:#103
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4200
Mailing Address - Country:US
Mailing Address - Phone:925-455-5050
Mailing Address - Fax:925-667-2122
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:#103
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-455-5050
Practice Address - Fax:925-667-2122
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics