Provider Demographics
NPI:1639331127
Name:KERKULA, LEEMU VALERIE (MD)
Entity Type:Individual
Prefix:
First Name:LEEMU
Middle Name:VALERIE
Last Name:KERKULA
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 1:5201 PENNELL RD STE A
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-6502
Mailing Address - Country:US
Mailing Address - Phone:877-346-4543
Mailing Address - Fax:866-225-3490
Practice Address - Street 1:5201 PENNELL RD STE A
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-6502
Practice Address - Country:US
Practice Address - Phone:877-346-4543
Practice Address - Fax:866-225-3490
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024945570001Medicaid
PA1629397294OtherNPPES