Provider Demographics
NPI:1467530618
Name:LEICHT, LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:LEICHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8483 SILVERWIND DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-1730
Mailing Address - Country:US
Mailing Address - Phone:989-657-1370
Mailing Address - Fax:901-821-0341
Practice Address - Street 1:1282 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3414
Practice Address - Country:US
Practice Address - Phone:989-657-1370
Practice Address - Fax:818-671-2225
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILL069193174400000X
TN48942174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529398Medicaid
MILL069193OtherSTATE LIS #
MI4657739Medicaid
TN4337224OtherBCBS OF TN
NC5921502Medicaid
TN1529398Medicaid
MI4657739Medicaid
MI4657739Medicaid