Provider Demographics
NPI:1497965693
Name:MARCAYDA, LEO (PT)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:MARCAYDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5847
Mailing Address - Country:US
Mailing Address - Phone:219-942-3051
Mailing Address - Fax:219-947-3132
Practice Address - Street 1:1230 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5847
Practice Address - Country:US
Practice Address - Phone:219-942-3051
Practice Address - Fax:219-947-3132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003904A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist