Provider Demographics
NPI:1669639084
Name:MULLIS, LEILANI SAUM (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILANI
Middle Name:SAUM
Last Name:MULLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:ESKENAZI HEALTH ANESTHESIA - SECOND FLOOR HOSPITAL
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-5386
Mailing Address - Fax:317-880-0488
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:ESKENAZI HEALTH ANESTHESIA - SECOND FLOOR HOSPITAL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5166
Practice Address - Country:US
Practice Address - Phone:317-880-5386
Practice Address - Fax:317-880-0488
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11013098A390200000X
IN01066821A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program