Provider Demographics
NPI:1427380708
Name:IKER LEYCEGUI, M.D., P.A.
Entity Type:Organization
Organization Name:IKER LEYCEGUI, M.D., P.A.
Other - Org Name:MEDIKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, SOLE OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IKER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYCEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-873-1919
Mailing Address - Street 1:PO BOX 880472
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-0472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 CENTRAL PARK WEST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-873-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty