Provider Demographics
NPI:1659668234
Name:LEINGANG-PITRONE, KELLI ELIZABETH (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ELIZABETH
Last Name:LEINGANG-PITRONE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 KYLE RD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-9715
Mailing Address - Country:US
Mailing Address - Phone:937-478-3026
Mailing Address - Fax:
Practice Address - Street 1:4083 KYLE RD
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-9715
Practice Address - Country:US
Practice Address - Phone:937-478-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH258580Medicare PIN