Provider Demographics
NPI:1538139449
Name:LEACH, KIMBERLY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:LEACH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:838 W ELLIOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5162
Mailing Address - Country:US
Mailing Address - Phone:480-374-7354
Mailing Address - Fax:480-371-1121
Practice Address - Street 1:4566 E INVERNESS AVE STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4633
Practice Address - Country:US
Practice Address - Phone:480-985-6000
Practice Address - Fax:480-985-8641
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0566213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95258Medicare UPIN
74893Medicare ID - Type Unspecified