Provider Demographics
NPI:1558537951
Name:LECKIE, STEVEN KOUFMAN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KOUFMAN
Last Name:LECKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 RESNIK RD BAY
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4842
Mailing Address - Country:US
Mailing Address - Phone:781-934-2400
Mailing Address - Fax:508-746-3930
Practice Address - Street 1:41 RESNIK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4842
Practice Address - Country:US
Practice Address - Phone:781-934-2400
Practice Address - Fax:508-746-3930
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190275207X00000X
PAMD444412207X00000X
GA68935207X00000X
MA259000207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery