Provider Demographics
NPI:1508391178
Name:MICHAEL PATRICK LEATHERS, M.D., INC
Entity Type:Organization
Organization Name:MICHAEL PATRICK LEATHERS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-732-3000
Mailing Address - Street 1:2801 K ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5120
Mailing Address - Country:US
Mailing Address - Phone:916-732-3000
Mailing Address - Fax:
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:SUITE 330
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-732-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125866207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty